Noninvasive Ventilation for Treatment of Acute Respiratory Failure Secondary to Severe Acute Respiratory Syndrome_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

XU Yuanda , JIANG Mei , XIAO Zhenglun.

State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease. Guangzhou, Guangdong,510120, ChinaCorresponding Author: XU Yuan-da, E-mail: xuyuanda@ sina. com;

Corresponding author：

Keywords：

Severe acute respiratory syndrome; Noninvasive ventilation; Acute lung injury; Acute respiratory distress syndrome

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Objective To investigate the effects of noninvasive ventilation for the treatment of acute respiratory failure secondary to severe acute respiratory syndrome ( SARS) . Methods 127 patients with complete information were collected from the database of SARS in Guangdong province, who were all consistent with the ALI/ARDS diagnostic criteria. The patients were divided into three groups depending on ventilation status, ie. a no-ventilation group, a noninvasive ventilation group, and a mechanical ventilation group. The outcome of ventilation treatmentwas followed up.Multi-factor regression analysis was conducted to analyze the relations of ventilation treatment with ARDS and mortality, and factors associated with success of noninvasive ventilation. Results As soon as the patients met the diagnostic criteria of ALI/ARDS, the patients in the noninvasive ventilation group were in more serious condition and had a higher proportion of ARDS compared with the no-ventilation group ( P lt;0. 01) . The patients in the mechanical ventilation group had a higher mortality rate ( P lt;0.01) . 6 and 7 patients in the no-ventilation group had noninvasive ventilation and invasive ventilation thereafter, respectively. 15 patients in the noninvasive group switched to invasive ventilation. Compared with the patients without ventilation ( n =45) , the patients receiving noninvasive ventilation ( n = 61) were in more serious condition and at higher risk of developing ARDS ( P lt;0. 01) , but the mortality was not different between them ( P gt; 0. 05) . The patients who continued to receive noninvasive ventilation ( n = 40) were in more serious condition, and at higher risk of developing ARDS compared with the patients without ventilation ( n = 45) ( P lt; 0. 01) . 15 patients in the noninvasive group who switched to invasive ventilation were older than those patients continuing noninvasive ventilation.Conclusions For SARS patients fulfilling the ALI/ARDS criteria, the patients underwent noninvasive ventilation are more severe, run a higher probability of developing ARDS from ALI. But earlier initiation of noninvasive ventilation has no impact on mortality. The patients who tolerate noninvasive ventilation can avoid intubation, especially for young patients. However, the time and indication of shifting from noninvasive ventilation to invasive ventilation should be emphasized.

Citation： XU Yuanda,JIANG Mei,XIAO Zhenglun.. Noninvasive Ventilation for Treatment of Acute Respiratory Failure Secondary to Severe Acute Respiratory Syndrome. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(6): 575-579. doi: Copy

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13.	郑则广, 黎毅敏, 陈荣昌, 等. 无创通气治疗SARS 病ARDS 的作用及其影响因素. 广州医学院学报, 2004, 32 : 21-24.
14.	Sevransky JE, Levy MM, Marini JJ. Mechanical ventilation in sepsisinduced acute lung injury /acute respiratory distress syndrome: An evidence-based review. Critical Care Med, 2004, 32: S548-S553.
15.	罗益锋, 谢灿茂, 曾勉, 等. 无创通气治疗肾移植术后巨细胞病毒肺炎临床疗效观察. 中国呼吸与危重监护杂志, 2008, 7:431-434.

1. 陈荣昌, 曾运祥, 黎毅敏, 等. 用面( 鼻) 罩压力支持辅助通气治疗慢性呼吸衰竭急性加重患者. 中华结核和呼吸杂志, 1992 ,15: 285-287.
2. 陈荣昌, 张秀燕, 何国清, 等. 改进的面罩对无创人工通气死腔效应的影响. 中华结核和呼吸杂志, 2000, 23: 734-736 .
3. Hess DR. The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: a systematic review of the literature. Respir Care, 2004, 49: 810-829 .
4. 中华人民共和国卫生部办公厅. 传染性非典型肺炎临床诊断标准. 中华人民共和国卫生部, 2003.
5. Nava S, Ceriana P. Causes of failure of noninvasive mechanical ventilation. Respir Care, 2004 , 49 : 295-303.
6. Rana S, Jenad H, Gay PC, et al. Failure of non-invasive ventilation in patients with acute lung injury: observational cohort study. Critical Care, 2006, 10: R79 .
7. Girault C, Briel A, Hellot MF, et al. Noninvasive mechanical ventilation in clinical practice: A 2-year experience in a medical intensive care unit. Crit Care Med, 2003, 31: 552 -559.
8. Lightowler JV, Wedzicha JA, Elliott MW, et al. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ, 2003, 326: 185 -187.
9. Keenan SP, Sinuff T, Cook DJ, et al. Does noninvasive positive pressure ventilation improve outcome in acute hypoxemic respiratory failure? A systematic review. Crit Care Med, 2004, 32 : 2516 -2523.
10. Kolodziej MA, Jensen L, Rowe B, et al. Systematic review of noninvasive positive pressure ventilation in severe stable COPD. Eur Respir J, 2007, 30 : 293-306.
11. Drosten C, Gunther S, Preiser W, et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med, 2003 , 348: 1967-1976.
12. 吴蓁, 汪均陶. 后SARS 时期无创通气呼吸机的合理利用. 中国医疗器械信息, 2003, 9: 43-45.
13. 郑则广, 黎毅敏, 陈荣昌, 等. 无创通气治疗SARS 病ARDS 的作用及其影响因素. 广州医学院学报, 2004, 32 : 21-24.
14. Sevransky JE, Levy MM, Marini JJ. Mechanical ventilation in sepsisinduced acute lung injury /acute respiratory distress syndrome: An evidence-based review. Critical Care Med, 2004, 32: S548-S553.
15. 罗益锋, 谢灿茂, 曾勉, 等. 无创通气治疗肾移植术后巨细胞病毒肺炎临床疗效观察. 中国呼吸与危重监护杂志, 2008, 7:431-434.

Chinese Journal of Respiratory and Critical Care Medicine

Noninvasive Ventilation for Treatment of Acute Respiratory Failure Secondary to Severe Acute Respiratory Syndrome

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