Objectives: Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with severe type II respiratory failure have a high probability of ventilation failure using conventional non-invasive positive pressure ventilation (NPPV). This study aims to investigate the clinical efficacy of high intensity NPPV (HI-NPPV) for the treatment of AECOPD combined with severe type II respiratory failure.
Methods: The data of patients with AECOPD combined with severe type II respiratory failure (blood gas analysis pH≤7.25) treated with NPPV in the Second Affiliated Hospital of Chongqing Medical University from July 2013 to July 2023 were collected to conduct a retrospective case-control study. The patients were divided into 2 groups according to the inspired positive airway pressure (IPAP) used during the NPPV treatment: a NPPV group (IPAP<20 cmH2O, 1 cmH2O=0.098 kPa) and a HI-NPPV group (20 cmH2O≤IPAP< 30 cmH2O). Ninety-nine and 95 patients were included in the NPPV group and the HI-NPPV group, respectively. A total of 86 pairs of data were matched using propensity score matching (PSM) for data matching. The primary outcome indexes (mortality and tracheal intubation rate) and secondary outcome indexes [blood gas analysis pH, arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2), adverse reaction rate, and length of hospitalization] were compared between the 2 groups.
Results: The tracheal intubation rates of the NPPV group and the HI-NPPV group were 6.98% and 1.16%, respectively, and the difference between the 2 groups was statistically significant (χ2=4.32, P<0.05); the mortality of the NPPV group and the HI-NPPV group was 23.26% and 9.30%, respectively, and the difference between the 2 groups was statistically significant (χ2=11.64, P<0.01). The PaO2 at 24 h and 48 h after treatment of the HI-NPPV group was higher than that of the NPPV group, and the PaCO2 of the HI-NPPV group was lower than that of the NPPV group, and the differences were statistically significant (all P<0.05). The differences of pH at 24 h and 48 h after treatment between the 2 groups were not statistically significant (both P>0.05). The differences between the 2 groups in adverse reaction rate and hospitalization length were not statistically significant (both P>0.05).
Conclusions: HI-NPPV can reduce mortality and tracheal intubation rates by rapidly improving the ventilation of patients with AECOPD combined with severe type II respiratory failure. This study provides a new idea for the treatment of patients with AECOPD combined with severe type II respiratory failure.
目的: 慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease，AECOPD)合并严重II型呼吸衰竭患者使用常规无创正压通气(non-invasive positive pressure ventilation，NPPV)通气失败的概率较高。本研究旨在探讨高压力NPPV(high intensity NPPV，HI-NPPV)治疗AECOPD合并严重II型呼吸衰竭的临床疗效。方法: 收集2013年7月至2023年7月因AECOPD伴严重II型呼吸衰竭(血气分析pH值≤7.25)在重庆医科大学附属第二医院进行NPPV治疗的患者资料，进行回顾性病例对照研究。根据NPPV治疗过程中采用的吸气相气道正压(inspired positive airway pressure，IPAP)将患者分为2组：NPPV组(IPAP<20 cmH2O，1 cmH2O=0.098 kPa)和HI-NPPV组(20 cmH2O≤IPAP<30 cmH2O)。NPPV组和HI-NPPV组分别纳入99和95例患者。通过倾向性得分匹配法(propensity score matching，PSM)进行数据配比，共匹配得到86对数据。比较2组的主要结局指标(病死率、气管插管率)及次要结局指标[血气分析的pH值、动脉血氧分压(arterial partial pressure of oxygen，PaO2)和动脉血二氧化碳分压(arterial partial pressure of carbon dioxide，PaCO2)，不良反应率，住院时长]。结果: NPPV组和HI-NPPV组的气管插管率分别为6.98%和1.16%，2组之间差异有统计学意义(χ2=4.32，P<0.05)；NPPV组和HI-NPPV组的病死率分别为23.26%和9.30%，2组之间差异有统计学意义(χ2=11.64，P<0.01)。HI-NPPV组治疗后24、48 h的PaO2均高于NPPV组，PaCO2均低于NPPV组，差异均有统计学意义(均P<0.05)；治疗后24、48 h，2组之间pH值的差异无统计学意义(均 P>0.05)。2组在不良反应率、住院时长方面的差异均无统计学意义(均P>0.05)。结论: HI-NPPV可通过迅速改善AECOPD合并严重II型呼吸衰竭患者的通气状态，从而降低病死率及插管率，本研究为AECOPD合并严重II型呼吸衰竭患者的治疗提供了新的思路。.
Keywords: acute exacerbation of chronic obstructive pulmonary disease; high intensity non-invasive positive pressure ventilation; severe type Ⅱ respiratory failure.