The Use of Ventilator Parameters to Predict the Successful Weaning of Non-invasive Positive Pressure Ventilator in Patients with Acute Respiratory Failure

• Main Authors: CHIU,CHU-YA, 邱琡雅
• Other Authors: WANG,JYE
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/7b8x4m

碩士 === 長榮大學 === 醫務管理學系碩士班 === 107 === Background Noninvasive positive pressure ventilation has been widely used for the care of patients with acute respiratory failure in intensive care units as an alternative to endotracheal intubation. However, past studies that examined the predictors of successful use of this treatment had mostly used laboratory test results as predictors. Few studies have investigated whether some important ventilator parameters, such as respiratory rate, tidal volume, rapid shallow breathing index, lung compliance, and airway resistance, predict successful use of noninvasive positive pressure ventilation. This study will be one of the first in Taiwan to explore the predictors of successful use of noninvasive positive pressure ventilation within seventy-two hours after its use. Method 148 patients with acute respiratory failure treated in a regional hospital in southern Taiwan were included in this retrospective analysis. We collected data on the respiratory rate, tidal volume, rapid shallow breathing index, lung compliance, airway resistance, fraction of inspired oxygen (FiO2), and the Glasgow coma scale(GCS) at 0, 2, 4, 6, 12, 24, 48 hours after the start of noninvasive positive pressure ventilation. For each of the seven time-dependent covariates, we defined five time-varying covariates. Cox’s proportional hazards models were used for analysis. Result 75 patients (50.67%) successfully weaned from noninvasive positive pressure ventilation within 72 hours. Among the thirty-five time-dependent covariates, the following conditions significantly predict the success of the treatment: the slope of the airway resistance change was between -1.30 and 0.04 (HR=25.34), the change in FiO2 used was<10% (HR=12.03), mean value of lung compliance before the successful detachment was greater than 86.58 ml/cm H2O (HR=4.91), the average respiratory rate was between 26.86 ~ 40.66 breaths/min (HR=3.23), the value of lung compliance closest to successful detachment was between 40.38 and 105.77 ml/cm H2O (HR=3.04), the initial respirator-set oxygen concentration<38% (HR=2.34), the initial rapid shallow breathing index ranged from 81.57 to 146.61 breaths/min/L (HR=2.27), scores for the coma scale closest to the successful detachment was greater than 12.18 (HR=3.68). On the other hand, those with higher initial respiratory rate (HR=0.9) and those with higher respiratory rate closest to successful detachment (HR=0.8) were more likely to fail. Conclusions Noninvasive positive pressure ventilation is increasingly used in intensive care unit for the care of acute respiratory failure patients. In this study, we explored factors that can predict success of this treatment in a timely and non-invasive fashion, that is, using respiratory parameters to predict whether a patient will successfully wean from noninvasive positive pressure ventilation within 72 hours. This study provides several simple and objective indicators to help clinicians identify high-risk cases to avoid delaying intubation.