中国における非侵襲的換気のための集中治療室用人工呼吸器対専用人工呼吸器の使用：前向き観察研究の二次解析

To evaluate the efficacy of intensive care unit ventilators versus dedicated noninvasive ventilators when used for noninvasive ventilation.

This was a secondary analysis of data from a multicenter prospective observational study. Eligible patients were recruited from 17 hospitals in China between September 2017 and September 2021. Inclusion criteria were restricted to those receiving noninvasive ventilation for acute hypoxemic respiratory failure. The type of ventilator used was determined at the discretion of the treating clinicians. The primary objective was to compare clinical outcomes between intensive care unit ventilators and dedicated noninvasive ventilation ventilators for noninvasive ventilation delivery. Key outcomes included noninvasive ventilation failure rate, 28-day mortality, intensive care unit length of stay, and hospital length of stay.

A total of 2054 patients were enrolled, with 5% (n = 103) receiving noninvasive ventilation via intensive care unit ventilators and 95% (n = 1951) via dedicated noninvasive ventilation ventilators. No significant difference was observed in the overall noninvasive ventilation failure rate between the two groups (46% versus 38%, p = 0.15). However, the median time from noninvasive ventilation initiation to endotracheal intubation was shorter in the intensive care unit ventilator group (9 h, interquartile range: 3-25) compared with the dedicated noninvasive ventilation ventilator group (21 h, interquartile range: 6-65). The 28-day cumulative incidence of noninvasive ventilation failure was significantly higher in the intensive care unit ventilator group (log-rank test p = 0.01; crude hazard ratio = 1.43, 95% confidence interval: 1.06-1.91; adjusted hazard ratio = 1.41, 95% confidence interval: 1.04-1.93). No significant difference was found in 28-day mortality between the groups (16% versus 17%, p = 0.79). The 28-day cumulative incidence of mortality also did not differ (log-rank test p = 0.65; crude hazard ratio = 0.84, 95% confidence interval: 0.52-1.34; adjusted hazard ratio = 0.95, 95% confidence interval: 0.58-1.55).

The use of intensive care unit ventilators for noninvasive ventilation is uncommon in China. Based on low-level evidence, intensive care unit ventilators are not associated with a difference in mortality compared with dedicated noninvasive ventilation ventilators, but are linked to earlier endotracheal intubation.