哮喘联盟

   摘要
   背景：目前在哮喘急性发作(AAE)中无创 (NIV) 和创伤性机械通气的使用频繁，但是他们对于结果的关联性是未知的。
   方法：本研究采用全国住院患者样本以确定以AAE为主要诊断的出院患者。确定每一个出院患者在住院的前两天开始是否使用NIV或创伤性机械通气。采用多因素logistic回归分析校正潜在的混杂因素，确定2000～2008年间机械通气的使用和住院死亡率是否有变化。
   结果：从2000～2008年，哮喘急性发作(AAE)患者数增加了15.8%。最初两天使用创伤性机械通气的住院比例，从2000年1.4%下降到2008年0.73%，而无创性机械通气(NIV)从0.34%增加到1.9%。2000～2008年需要NIV或创伤性机械通气的哮喘急性发作患者校正死亡率无变化。LOS也无变化。
   结论：机械通气的使用呈大幅增长，并逐渐由创伤性机械通气转变为无创性机械通气，。尽管不能确定这种增长趋势的临床原因，但LOS和死亡率是无变化的。但在广泛应用前，尚需进行一项随机试验以确定NIV是否能够改善哮喘急性发作的预后。
 

（林江涛 审校）
Respir Care. 2013 Oct 8. [Epub ahead of print]


 

Utilization of Mechanical Ventilation for Asthma Exacerbations -- Analysis of a National Database.
 

Nanchal R, Kumar G, Majumdar T, Taneja A, Patel J, Dagar G, Jacobs ER, Whittle J; From the Milwaukee Initiative in Critical Care Outcomes Research (MICCOR) Group of Investigators.
 

ABSTRACT
BACKGROUND:The current frequency of non-invasive (NIV) and invasive mechanical ventilation use in acute asthma exacerbations (AAE) and their relationship to outcomes is unknown.
METHODS:We used the Nationwide Inpatient Sample to identify patients discharged with a principal diagnosis of AAE. For each discharge we determined whether NIV or invasive mechanical ventilation was initiated during the first two hospital days. Using multivariable logistic regression to adjust for potential confounders, we determined whether use of mechanical ventilation and in-hospital mortality changed between 2000 and 2008.
RESULTS: The number of AAE increased by 15.8% from 2000 to 2008. The proportion of admissions where invasive mechanical ventilation was used during the first 2 days decreased from 1.4% in 2000 to 0.73% in 2008 while NIV increased from 0.34% to 1.9%. The adjusted mortality in AAE requiring NIV or invasive mechanical ventilation was unchanged through 2000 to 2008. LOS was also unchanged.
CONCLUSION: There was a substantial increase in the use of mechanical ventilation, accompanied by a shift from invasive mechanical ventilation to NIV. Although we cannot determine the clinical reasons for this increase, LOS and mortality were unchanged. A randomized trial is needed to determine whether NIV can improve outcomes in AAE, before widespread adoption makes it impossible to conduct such a trial.
 

Respir Care. 2013 Oct 8. [Epub ahead of print]