PaCO<sub>2</sub> is nonlinearly associated with NIV failure in patients with hypoxemic respiratory failure
作者全名：Xu, Xiaoping; Ma, Mengyi; Min, Yiwei; Hu, Wenhui; Bai, Linfu; Duan, Jun
作者地址：[Xu, Xiaoping; Ma, Mengyi; Min, Yiwei; Hu, Wenhui; Bai, Linfu; Duan, Jun] Chongqing Med Univ, Affiliated Hosp 1, Dept Resp & Crit Care Med, Youyi Rd 1, Chongqing 400016, Peoples R China
通信作者：Duan, J (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Resp & Crit Care Med, Youyi Rd 1, Chongqing 400016, Peoples R China.
来源：BMC PULMONARY MEDICINE
ESI学科分类：CLINICAL MEDICINE
WOS号：WOS:001218469100003
JCR分区：Q2
影响因子：2.6
年份：2024
卷号：24
期号：1
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结束页：
文献类型：Article
关键词：Noninvasive ventilation; PaCO2; Restricted cubic splines; Hypoxemic respiratory failure
摘要：Objective To explore the association between PaCO2 and noninvasive ventilation (NIV) failure in patients with hypoxemic respiratory failure. Methods A retrospective study was performed in a respiratory ICU of a teaching hospital. Patients admitted to ICU between 2011 and 2019 were screened. We enrolled the patients with hypoxemic respiratory failure. However, patients who used NIV due to acute-on-chronic respiratory failure or heart failure were excluded. Data before the use of NIV were collected. Requirement of intubation was defined as NIV failure. Results A total of 1029 patients were enrolled in final analysis. The rate of NIV failure was 45% (461/1029). A nonlinear relationship between PaCO2 and NIV failure was found by restricted cubic splines (p = 0.03). The inflection point was 32 mmHg. The rate of NIV failure was 42% (224/535) in patients with PaCO2 >32 mmHg. However, it increased to 48% (237/494) in those with PaCO2 <= 32 mmHg. The crude and adjusted hazard ratio (HR) for NIV failure was 1.36 (95%CI:1.13-1.64) and 1.23(1.01-1.49), respectively, if the patients with PaCO2 >32 mmHg were set as reference. In patients with PaCO2 <= 32 mmHg, one unit increment of PaCO2 was associated with 5% reduction of NIV failure. However, it did not associate with NIV failure in patients with PaCO2 >32 mmHg. Conclusions PaCO2 and NIV failure was nonlinear relationship. The inflection point was 32 mmHg. Below the inflection point, lower PaCO2 was associated with higher NIV failure. However, it did not associate with NIV failure above this point.
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