Risk factors involved in failure of using invasive mechanical ventilation for emergency treatment of patients with acute exacerbation of obstructive pulmonary disease / 中国中西医结合急救杂志

ABSTRACT

Objective To analyze the risk factors of failure of emergency treatment with invasive mechanical ventilation (IPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The clinical data of 122 patients with AECOPD to undergo IPPV admitted to the Emergency Center of Kaifeng Central Hospital from July 2015 to March 2018 were retrospectively analyzed. The patient's general information [gender, age, body mass index (BMI)] and the patient's body temperature (T) at initial IPPV, respiratory rate (RR), mean arterial pressure (MAP), heart rate (HR), white blood cell count (WBC), hemoglobin (Hb), electrolyte (K+, Na+ and Cl-), pH value, D-dimer, albumin, C-reactive protein (CRP), blood lactic acid (Lac), B-type brain natriuretic peptide (BNP), procalcitonin (PCT), serum creatinine (SCr), oxygenation index, respiratory index (RI), the occurrence of serious arrhythmia or not, Glasgow coma score (GCS) were statistically analyzed. The indicators with statistical significance in the univariate analysis were introduced into the multivariate Logistic regression analysis to screen out the risk factors affecting the failure of IPPV in the patients; receiver operating characteristic (ROC) curve was drawn to analyze the test effectiveness of the risk factors. Results There were totally 98 cases underwent emergency IPPV, failure in 17 cases and success in 81 cases. The levels of oxygenation index, pH value, WBC and GCS scores of the IPPV success group were significantly higher than those of the IPPV failure group [oxygenation index (mmHg, 1 mmHg =0.133 kPa) 304.10±115.35 vs. 285.93±184.64, pH value 7.34±0.17 vs. 7.18±0.24, WBC (×109/L) 40.90±8.72 vs. 26.61±6.86, GCS score 12.42±1.35 vs. 9.89±2.13, all P < 0.05]; the levels of RI, D-dimer, PCT, Lac and incidence of serious arrhythmia in the IPPV success group were significantly lower than those in the IPPV failure group [RI 2.53±2.39 vs. 3.69±3.64, D-dimer (mg/L) 1.80±0.06 vs. 3.16±2.60, PCT (μg/L) 1.36±0.65 vs. 2.23±2.07, Lac (mmol/L) 3.98±0.63 vs. 7.06±3.44, incidence of serious arrhythmia 23.46% (19/81) vs. 47.06% (8/17), all P < 0.05]. Logistic regression analysis showed that RI [odds ratio (OR) = 3.479, 95% confidence interval (95%CI)= 1.248-11.996], pH value (OR = 3.153, 95%CI = 1.256-8.656), WBC (OR = 3.364, 95%CI = 1.171-11.561), and the occurrence of severe arrhythmia (OR = 4.125, 95%CI = 0.042-0.342) were risk factors affecting the prognosis of AECOPD patients treated with IPPV (all P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of RI, pH value, WBC and occurrence of severe arrhthmia was 0.718 (P = 0.012), 0.832 (P = 0.008), 0.645 (P = 0.004), 0.617 (P = 0.003), and the sensitivity were 37.0%, 55.6%, 81.5%, 60.4%, the specificity were 19.1%, 26.8%, 60.3%, 83.0% respectively, that had certain value to predict the failure of using IPPV to treat patients with AECOPD. Conclusion Multiple factors may result in failure in emergency patients with AECOPD to apply invasive mechanical ventilator for treatment, that may lead to death, and RI, pH value, WBC, the occurrence of severe arrhythmia are the independent risk factors of failure in such patients using IPPV; emergency physicians should pay attention to AECOPD patients' risk factors at initial period of using IPPV in order to give early warning after assessment.