慢性呼吸衰竭患者从 NIV 到 CPAP 转换的实际生活评估。病例对照研究。

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM Respiratory Medicine and Research Pub Date : 2024-05-02 DOI:10.1016/j.resmer.2024.101114

Louise Mathieu , Claudio Rabec , Guillaume Beltramo , Serge Aho , Pierre Tankere , Déborah Schenesse , Jade Chorvoz , Philippe Bonniaud , Marjolaine Georges

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引用次数: 0

摘要

背景无创通气（NIV）是治疗高碳酸血症慢性呼吸衰竭（CRF）的标准疗法。阻塞性睡眠呼吸暂停综合征（OSA）经常导致慢性呼吸衰竭患者通气不足。与 NIV 一样，CPAP 可改善部分慢性阻塞性肺疾病和肥胖患者的高碳酸血症。在这项病例对照研究中，我们将 2015 年至 2020 年期间第戎大学医院治疗的 394 名通气患者中，88 名连续的 NIV-CPAP 转换候选患者与 266 名对照组患者进行了比较。他们遵循标准化方案，包括在停用 NIV 三晚后记录多（体）液图。如果证实有严重的 OSA，则进行 CPAP 试验。结果53%的患者为男性，中位年龄为 65 [56-74] 岁，中位体重指数为 34 [25-38.5] kg/m2。64%的患者被安全转为长期使用 CPAP。在多变量分析中，NIV-CPAP转换的概率与年龄（OR：1.3 [1.01-1.06]）、体重指数（OR：1.7 [1.03-1.12]）、CRF病因（COPD的OR：20.37 [4.2-98,72]，肥胖的OR：7.31 [1.58-33.74]）、NIV的情况相关。74]）、开始 NIV 的情况（急性加重的 OR：11.64 [2.03-66.62]）、较低的压力支持（OR：0.90 [0.73-0.92]）、较低的基线 PaCO2（OR：0.85 [0.80-0.91]）和较低的依从性（OR：0.76 [0.64-0.90]）。在使用 CPAP 回家的 72 名患者中，压力支持水平是唯一与 NIV-CPAP 转换结果相关的因素，即使在调整了体重指数和年龄后也是如此（P = 0.01），且存在非线性相关性。慢性呼吸衰竭的病因、年龄、体重指数、基线 PaCO2、开始 NIV 的情况、在家 NIV 的时间或 NIV 的依从性均不能预测 NIV-CPAP 转换的结果。

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Real-life evaluation of NIV to CPAP switch in patients with chronic respiratory failure. A case control study

Background

Non-invasive ventilation (NIV) is a standard of care for hypercapnic chronic respiratory failure (CRF). Obstructive sleep apnea syndrome (OSA) frequently contributes to hypoventilation in CRF patients. CPAP improves hypercapnia in selected COPD and obese patients, like NIV. We aimed to describe the profile of patients switching from NIV to CPAP in a cohort of patients on long-term ventilation and to identify the factors associated with a successful switch.

Methods

In this case-control study, 88 consecutive patients who were candidates for a NIV-CPAP switch were compared with 266 controls among 394 ventilated patients treated at the Dijon University Hospital between 2015 and 2020. They followed a standardized protocol including a poly(somno)graphy recorded after NIV withdrawal for three nights. CPAP trial was performed if severe OSA was confirmed. Patients were checked for recurrent hypoventilation after 1 and 23[14–46] nights under CPAP.

Results

Patients were 53% males, median age 65 [56–74] years, and median BMI 34 [25–38.5] kg/m². Sixty four percent of patients were safely switched and remained on long-term CPAP. In multivariate analysis, the probability of a NIV-CPAP switch was correlated to older age (OR: 1.3 [1.01–1.06]), BMI (OR: 1.7 [1.03–1.12]), CRF etiology (OR for COPD: 20.37 [4.2–98,72], OR for obesity: 7.31 [1.58–33.74]), circumstances of NIV initiation (OR for acute exacerbation: 11.64 [2.03–66.62]), lower pressure support (OR: 0.90 [0.73–0.92]), lower baseline PaCO₂ (OR: 0.85 [0.80–0.91]) and lower compliance (OR: 0.76 [0.64–0.90]). Among 72 patients who went home under CPAP, pressure support level was the only factor associated with the outcome of the NIV-CPAP switch, even ^{after adjustment for BMI and age (}^p ⁼ ^0.01) with a non-linear correlation. Etiology of chronic respiratory failure, age, BMI, baseline PaCO₂, circumstances of NIV initiation, time under home NIV or NIV compliance were not predictive of the outcome of the NIV-CPAP switch.