Non-invasive mechanical ventilation in patients with influenza
A-associated acute respiratory distress syndrome: a retrospective study
Abstract
Background:The inappropriate mechanical ventilation strategy could
improve the mortality rate of patients with influenza A-associated
ARDS.Therefore, clinical data are needed to support the timing of NIV
therapy for patients with influenza A-associated ARDS. Methods: For this
retrospective cohort study, data were obtained from the Fuzhou Pulmonary
Hospital of Fujian, China. Differences in baseline factors, risk
factors, and outcome parameters were studied between patients with and
without invasive mechanical ventilation. Results: Among this cohort, 24
patients received successful NIV with an average age of (57.96±17.08)
years. NIV failure occurred in 21 patients with an average age of
(54.19±14) years. Mortality data were obtained for the successful NIV
group and the mortality rate was lower than in the failed NIV group
[4.17%vs42.86%, X2=7.591, P = 0.003]. The independent risk factors
for the success of NIV were APACHE II score and LDH (OR=1.830, 95%CI
1.105-3.032 and OR=1.011, 95% CI 1.001-1.020, respectively). When the
OI is <95 mmHg, APACHE II>19 and
LDH>498U/L, the sensitivity and specificity of predicting
failed NIV were [66.67% (95% CI 43% - 85.4%) , 87.5% (95% CI
67.6% - 97.3%)], [85.71% (95% CI 63.7%-97%), 79.17% (95% CI
57.8%-92.9%)] and [90.48% (95% CI 69.6%-98.8%), 62.5% (95%
CI 40.6%-81.2%)], respectively. Conclusions: Overall, patients with
influenza A-associated ARDS receiving successful NIV have lower
mortality rates than those for whom NIV failed. Independent risk factors
for successful NIV are LDH and APACHE II scores.Invasive mechanical
ventilation can possibly be avoided in some patients with 200 mmHg
> OI > 95 mmHg.