The Clinical Evaluation Of Noninvasive Positive Pressure Ventilation In The Treatment Of Acute Respiratory Failure Caused By Immunocompromised Pneumonia

Objective:We aimed to evaluate the efficacy and predictive factors of noninvasive positive pressure ventilation?NIPPV?failing in immunocompromised patients with acute respiratory failure due to pneumonia.Methods:We retrospectively analyzed the clinical data of 118 immunocompromised patients treated with NIPPV in the respiratory ICU?with 25 beds?of the first hospital of Xinjiang Medical University between February 2012 to February 2017.Subjects were divided into un-intubation group?NIPPV successful group,62 cases?and intubation group?NIPPV failing group,56 cases?according to whether to perform ETI during hospital period.Each observed indicator was analyzed by univariate analysis,and factors leading to NIPPV failing were further analyzed by logistic regression.Receiver operating characteristic curve?ROC?was plotted to evaluate the predictive value of risk factors for NIPPV in immunocompromised patients with acute respiratory failure due to pneumonia.Results:The un-intubated rate for NIPPV in immunocompromised patients was 52.5%?62/118?.Compared with the un-intubation group,intubation group of the body temperature was higher [?:?37.71±0.98?VS.?37.38± 0.76?,t=-2.011,P=0.047];pH value[?7.42±0.02?VS.?7.41±0.03?,t=-2.088,P=0.039]was also higher;PaCO₂[mmHg:?32.28±1.63?VS.?32.99±1.76?,t=2.279,P=0.025] was significantly lower;the rates of PaO₂/FiO₂< 100 mmHg[46.4%?26/56?VS.2.9%?8/62?,?2=16.123,P<0.001],of APECHE?score ?20 [91.1%?51/56?VS.48.4%?30/62?,?2=24.906,P<0.001] and of need for catecholamines [92.9%?52/56?VS.32.3%?20/62?,?2=45.426,P<0.001] were significantly higher.The mortality [83.9%?47/56?VS.3.2%?2/62?,?2=78.921,P< 0.001] had significant difference in both groups.However,there were no significant difference in underlying diseases and primary pneumonia?both P>0.05?.The indicators with statistically significant difference from the univariate analysis were further analyzed by multivariate logistic regression,and the indices included in the regression model were APACHE?score?20 [95%CI= 0.014-0.408,P=0.006]?PaO₂/FiO₂<100mmHg [95%CI =2.175-107.252,P=0.003] and need for catecholamines [95%CI =6.974-183.124,P< 0.001].It was shown by ROC curve analysis that the area under ROC curve?AUC?of APACHE? score?20 in predicting NIPPV failing in immunocompromised patients was 0.787,which was more than that of PaO₂/FiO₂ <100 mmHg,the sentivity,specificity,positive predict value?+PV?,negative predict value?-PV?,positive likelihood ratio?+LR?,negative likelihood ratio?+LR?,and Youden index was 83.93%,69.35%,71.21%,82.69%,2.74,0.23 and 0.53,respectively.Conclusions:52.5%of immunocompromised patients treated with NIPPV which did not require intubation and independent of the etiology of ARF.APACHE?score?20,PaO₂/FiO₂<100mm Hg and need for catecholamines are predictive factors of NIPPV failing in immunocompromised patients.