Clinical Prediction Score for Successful Weaning from Noninvasive Positive Pressure Ventilation (NIPPV) in Emergency Department; a Retrospective Cohort Study
学术急诊医学档案,
卷 10 编号 1 (2022),
1 一月 2022
,
第 e79 页
https://doi.org/10.22037/aaem.v10i1.1769
摘要
Introduction: Due to the lack of in-hospital beds, some patients with acute cardiogenic pulmonary edema are initiated and weaned off noninvasive positive pressure ventilation (NIPPV) at the emergency department (ED). This study aimed to develop a clinical score to predict successful weaning from NIPPV in these patients.
Methods: This retrospective cohort study was conducted on patients with acute cardiogenic pulmonary edema who received NIPPV at the ED of Ramathibodi Hospital, Bangkok, Thailand. Multivariable logistic regression analysis was used to developed a predictive model for weaning from NIPPV.
Results: 355 patients with acute cardiogenic pulmonary edema treated with NIPPV were studied (107 (30.14%) failed to be weaned). The significant risk factors of weaning failure based on multivariate analysis were age > 75 years (OR: 3.1, 95% CI: 1.15–8.33, p = 0.025), pneumonia (OR: 2.72, 95% CI: 1.39–5.31, p = 0.003), pulse rate > 80 bpm before NIPPV (OR: 1.74, 95% CI: 1.04–2.91, p = 0.033), and a urinary output < 150 cc/h while using NIPPV (OR: 2.93, 95% CI: 1.74–4.91, p < 0.001). In addition, clinically significant risk factors for weaning from NIPPV were age 60 – 75 years, respiratory rate > 26 breaths/min before weaning and oxygen saturation of < 97% as assessed by pulse oximetry before weaning from NIPPV. Since the lowest coefficient obtained was 0.46, the scores were split into groups of 0.5 points for each factor. Based on the area under the receiver operating characteristic (ROC) curve (71.3% (95% CI: 66.0–75.7%)), the cut point of risk score was divided into the low-risk with positive likelihood ratio of 0.48 (95% CI 0.33–0.69, P <0.001), the moderate-risk with positive likelihood ratio of 0.74 (95%CI 0.52–1.05, P = 0.080), and the high-risk group with positive likelihood ratio of 3.41 (95%CI 2.39–4.88, P <0.001) for predicting weaning failure.
Conclusions: In patients with acute cardiogenic pulmonary edema under the NIPPV, weaning is associated with a significant increasing risk of failure in age >75, presence of pneumonia, heart rate > 80 bpm before weaning, and urinary output < 150 cc/h during ventilation. Based on the designed model in this study, patients with score ≤ 3.5, 4–5, and > 5 points were in low, moderate, and severe risk of weaning failure, respectively.
- Noninvasive Ventilation
- ventilator weaning
- continuous positive airway pressure
- emergency service, hospital
- intubation
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参考
Collins SP, Mielniczuk LM, Whittingham HA, Boseley ME, Schramm DR, Storrow AB. The use of noninvasive ventilation in emergency department patients with acute cardiogenic pulmonary edema: a systematic review. Ann Emerg Med. 2006;48(3):260-9. e4.
Nava S, Carbone G, DiBattista N, Bellone A, Baiardi P, Cosentini R, et al. Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial. Am J Respir Crit Care Med. 2003;168(12):1432-7.
Masip J, Peacock WF, Price S, Cullen L, Martin-Sanchez FJ, Seferovic P, et al. Indications and practical approach to non-invasive ventilation in acute heart failure. Eur Heart J. 2018;39(1):17-25.
Weng C-L, Zhao Y-T, Liu Q-H, Fu C-J, Sun F, Ma Y-L, et al. Meta-analysis: noninvasive ventilation in acute cardiogenic pulmonary edema. Ann Intern Med. 2010;152(9):590-600.
Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50(2):1602426.
Vital FM, Ladeira MT, Atallah ÁN. Non‐invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. Cochrane Database Syst Rev. 2013(5):Cd005351.
Felker GM, Adams Jr KF, Konstam MA, O'Connor CM, Gheorghiade M. The problem of decompensated heart failure: nomenclature, classification, and risk stratification. Am Heart J. 2003;145(2 suppl):S18-S25.
Adam CT, Vieira CT, Aguiar SdC, Bündchen D, Vieira DSR. [Non-invasive mechanical ventilation weaning protocols: a systematic review]. Fisioter Pesqui. 2017;24(4):453-60. [Portuguese].
Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med. 2008;359(2):142-51.
Grace MP, Greenbaum DM. Cardiac performance in response to PEEP in patients with cardiac dysfunction. Crit Care Med. 1982;10(6):358-60.
Dobbe L, Rahman R, Elmassry M, Paz P, Nugent K. Cardiogenic pulmonary edema. Am J Med Sci. 2019;358(6):389-97.
Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet. 2009;374(9685):250-9.
McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971;285(26):1441-6.
Members: ATF, McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2022;24(1):4-131.
Duan J, Han X, Bai L, Zhou L, Huang S. Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive care med. 2017;43(2):192-9.
Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315.
Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364(9):797-805.
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2021;42(36):3599-726.
Lemyze M, Taufour P, Duhamel A, Temime J, Nigeon O, Vangrunderbeeck N, et al. Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure. PloS one. 2014;9(5):e97563.
Singh V, Khanna P, Rao B, Sharma S, Gupta R. Outcome predictors for non-invasive positive pressure ventilation in acute respiratory failure. J Assoc Physicians India. 2006;54:361-5.
Liengswangwong W, Yuksen C, Thepkong T, Nakasint P, Jenpanitpong C. Early detection of non-invasive ventilation failure among acute respiratory failure patients in the emergency department. BMC Emerg Med. 2020;20(1):80.
Momii H, Tashima Y, Kadokami T, Narita S, Yoshida M, Ando S-i. Experience of step-wise protocol using noninvasive positive pressure ventilation for treating cardiogenic pulmonary edema. Eur J Emerg Med. 2012;19(4):267-70.
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