无创正压通气应用与严重哮喘急性发作期临床结局的关联性：一项队列研究
2026/02/02
摘要
目的：支持在严重哮喘急性发作期使用无创正压通气（NPPV）的证据有限。本研究旨在确定所有因哮喘急性发作住院患者中，NPPV使用率、气管插管率及院内死亡率的年度变化趋势。此外，我们进一步评估了NPPV应用与后续气管插管及院内死亡率之间的关联。
设计：回顾性、倾向评分匹配队列研究。研究场所：基于美国医疗保健成本与利用项目（Healthcare Cost and Utilization Project）纽约州与佛罗里达州出院患者数据库（State Inpatient Databases）2006至2019年的行政数据。患者：因哮喘急性发作住院的5-80岁患者。干预措施：接受NPPV治疗。
测量指标与主要结果： 在2006年至2018年间共296788例因哮喘急性发作住院的患者中，成年患者NPPV使用率从1.2%上升至7.4%（绝对差值6.1%；95% CI, 5.6%—6.7%），儿科患者从0.7%上升至7.1%（绝对差值6.4%；95% CI, 5.5%—7.3%）。在41902次ICU住院记录中，我们通过倾向评分匹配了1972例接受NPPV的成年患者和1622例接受NPPV的儿科患者，分别与6,510例未接受NPPV的成年患者和4,766例未接受NPPV的儿科患者进行比较。结果显示，在成年患者中，NPPV的使用与后续气管插管风险降低（风险比[RR]为0.48；95% CI, 0.40-0.57）及院内死亡率改善（RR为0.33；95% CI, 0.21-0.54）相关。在儿科患者中，NPPV的使用与气管插管风险降低相关（RR为0.50；95% CI, 0.29-0.89），但对于改善院内死亡率则无统计学意义（RR为0.41；95% CI, 0.15-1.11）。
结论： 哮喘急性发作患者中NPPV的使用率有所增加。在成人和儿科患者中，哮喘急性发作期应用NPPV均与气管插管风险降低相关。此外，在成年患者中，哮喘急性发作期应用NPPV与院内死亡率改善相关。
Association Between Noninvasive Positive Pressure Ventilation Use and Clinical Outcomes During a Severe Asthma Exacerbation
Adam M, Matthew R, Abbott; Kayla P,
OBJECTIVES: The evidence supporting the use of noninvasive positive pressure ventilation (NPPV) during severe asthma exacerbations is limited. We determined the annual trend in NPPV use, endotracheal intubations, and in-hospital mortality among all hospitalizations for an asthma exacerbation. We additionally evaluated the association between NPPV use and subsequent endotracheal intubation and in-hospital mortality.
DESIGN: Retrospective, propensity-score-matched cohort study. SETTING: Administrative data from Healthcare Cost and Utilization Project's State Inpatient Databases for New York and Florida, 2006-2019. PATIENTS: Patients 5-80 years old hospitalized with an asthma exacerbation. INTERVENTIONS: Receipt of NPPV.
MEASUREMENTS AND MAIN RESULTS: Among 296,788 hospitalizations for an asthma exacerbation between 2006 and 2018, NPPV use for an asthma exacerbation increased from 1.2% to 7.4% (absolute difference, 6.1%; 95% CI, 5.6%—6.7%) in adults and from 0.7% to 7.1% (absolute difference, 6.4%; 95% CI, 5.5%—7.3%) in pediatric patients. Among 41,902 ICU encounters, we propensity-score matched 1,972 adult and 1,622 pediatric patients who received NPPV with 6,510 adults and 4,766 pediatric patients who did not receive NPPV. NPPV use was associated with a decreased risk of subsequent intubation (risk ratio [RR], 0.48; 95% CI, 0.40-0.57) and improved in-hospital mortality (RR, 0.33; 95% CI, 0.21-0.54) in adults. In pediatric patients, use of NPPV was associated with a decreased risk of intubation (RR, 0.50; 95% CI, 0.29-0.89), but not significant for an improvement in in-hospital mortality (RR, 0.41; 95% CI, 0.15-1.11).
CONCLUSIONS: NPPV use for asthma exacerbations has increased. In adult and pediatric patients, NPPV use for an asthma exacerbation was associated with a decreased risk of endotracheal intubation. Furthermore, NPPV use for an asthma exacerbation was associated with improved in-hospital mortality in adult patients.
目的：支持在严重哮喘急性发作期使用无创正压通气（NPPV）的证据有限。本研究旨在确定所有因哮喘急性发作住院患者中，NPPV使用率、气管插管率及院内死亡率的年度变化趋势。此外，我们进一步评估了NPPV应用与后续气管插管及院内死亡率之间的关联。
设计：回顾性、倾向评分匹配队列研究。研究场所：基于美国医疗保健成本与利用项目（Healthcare Cost and Utilization Project）纽约州与佛罗里达州出院患者数据库（State Inpatient Databases）2006至2019年的行政数据。患者：因哮喘急性发作住院的5-80岁患者。干预措施：接受NPPV治疗。
测量指标与主要结果： 在2006年至2018年间共296788例因哮喘急性发作住院的患者中，成年患者NPPV使用率从1.2%上升至7.4%（绝对差值6.1%；95% CI, 5.6%—6.7%），儿科患者从0.7%上升至7.1%（绝对差值6.4%；95% CI, 5.5%—7.3%）。在41902次ICU住院记录中，我们通过倾向评分匹配了1972例接受NPPV的成年患者和1622例接受NPPV的儿科患者，分别与6,510例未接受NPPV的成年患者和4,766例未接受NPPV的儿科患者进行比较。结果显示，在成年患者中，NPPV的使用与后续气管插管风险降低（风险比[RR]为0.48；95% CI, 0.40-0.57）及院内死亡率改善（RR为0.33；95% CI, 0.21-0.54）相关。在儿科患者中，NPPV的使用与气管插管风险降低相关（RR为0.50；95% CI, 0.29-0.89），但对于改善院内死亡率则无统计学意义（RR为0.41；95% CI, 0.15-1.11）。
结论： 哮喘急性发作患者中NPPV的使用率有所增加。在成人和儿科患者中，哮喘急性发作期应用NPPV均与气管插管风险降低相关。此外，在成年患者中，哮喘急性发作期应用NPPV与院内死亡率改善相关。
（中日友好医院呼吸与危重症医学科 万静萱 摘译 林江涛 审校）
（Crit Care Med 2026 Jan 14;(0). DOI:10.1097/CCM.0000000000007025 IF: 7.414）
（Crit Care Med 2026 Jan 14;(0). DOI:10.1097/CCM.0000000000007025 IF: 7.414）
Association Between Noninvasive Positive Pressure Ventilation Use and Clinical Outcomes During a Severe Asthma Exacerbation
Adam M, Matthew R, Abbott; Kayla P,
OBJECTIVES: The evidence supporting the use of noninvasive positive pressure ventilation (NPPV) during severe asthma exacerbations is limited. We determined the annual trend in NPPV use, endotracheal intubations, and in-hospital mortality among all hospitalizations for an asthma exacerbation. We additionally evaluated the association between NPPV use and subsequent endotracheal intubation and in-hospital mortality.
DESIGN: Retrospective, propensity-score-matched cohort study. SETTING: Administrative data from Healthcare Cost and Utilization Project's State Inpatient Databases for New York and Florida, 2006-2019. PATIENTS: Patients 5-80 years old hospitalized with an asthma exacerbation. INTERVENTIONS: Receipt of NPPV.
MEASUREMENTS AND MAIN RESULTS: Among 296,788 hospitalizations for an asthma exacerbation between 2006 and 2018, NPPV use for an asthma exacerbation increased from 1.2% to 7.4% (absolute difference, 6.1%; 95% CI, 5.6%—6.7%) in adults and from 0.7% to 7.1% (absolute difference, 6.4%; 95% CI, 5.5%—7.3%) in pediatric patients. Among 41,902 ICU encounters, we propensity-score matched 1,972 adult and 1,622 pediatric patients who received NPPV with 6,510 adults and 4,766 pediatric patients who did not receive NPPV. NPPV use was associated with a decreased risk of subsequent intubation (risk ratio [RR], 0.48; 95% CI, 0.40-0.57) and improved in-hospital mortality (RR, 0.33; 95% CI, 0.21-0.54) in adults. In pediatric patients, use of NPPV was associated with a decreased risk of intubation (RR, 0.50; 95% CI, 0.29-0.89), but not significant for an improvement in in-hospital mortality (RR, 0.41; 95% CI, 0.15-1.11).
CONCLUSIONS: NPPV use for asthma exacerbations has increased. In adult and pediatric patients, NPPV use for an asthma exacerbation was associated with a decreased risk of endotracheal intubation. Furthermore, NPPV use for an asthma exacerbation was associated with improved in-hospital mortality in adult patients.
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