| Objective By retrospectively analyzing the clinical data of patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease(AECOPD)complicated with respiratory failure,who were treated by invasive-noninvasive sequential ventilation,the aim is to explore the root causes of the treatment failure.Methods From January 1,2013 to September 30,2017,64 patients with AECOPD complicated with respiratory failure who underwent RICU in the respiratory department of Jiangning Hospital affiliated to Nanjing Medical University,was conducted a cohort study with who were treated by invasive-noninvasive sequential ventilation.Re-intubation,death or spontaneous discharge within 7d was following extubation as the endpoint.The APACHE-? score into RICU,the ABCD grouping for COPD,the ratio of the diameter of the pulmonary artery to the diameter of the ascending aorta in CT(PA:A ratio),the NT-proBNP,the PaC02,the Pa02,the total number of leukocytes and the procalcitonin were compared between the successful group(43 cases)and the failed group(21 cases).Results The APACHE-? score into RICU,the PA:A ratio,the NT-proBNP,the total leukocytes into RICU,and the procalcitonin into RICU showed significant difference in the univariate analysis(P<0.05).The average APACHE-II score was 23±4 in the successful group and 27±6 in the failed group.The average PA:A ratio was 0.88±0.09 in the successful group and 1.0310.10 in the failed group.In the multivariate regression analysis,there was significant difference only in the APACHE-II score(P=0.02)and the PA:A ratio(P=0.012).The area under the ROC curve of the PA:A ratio for all patients was 0.894 and the cut-off value of the PA:A ratio was 0.98.Conclusion The APACHE-? score and the PA:A ratio in CT are independent risk factors for the failure of sequential ventilation in AECOPD patients complicated with respiratory failure.In particular,patients with a PA:A ratio greater than 0.98 have a higher risk of treatment failure. |
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