The Role Of Non-invasive Positive Pressure Ventilation In Patients With Acute Respiratory Distress Syndrome Due To Viral Pneumonia

Objective:This paper aims to explore the efficacy and case selection of non-invasive positive pressure ventilation(NIPPV)in the treatment of Acute Respiratory Distress Syndrome(ARDS)caused by viral pneumonia.Methods:Those patients who were continuously admitted in the Respiratory Intensive Care Unit(RICU)of the First Affiliated Hospital of Xinjiang Medical University from December 2017 to June 2019 and met the inclusion and exclusion criteria were enrolled in this prospective cohort study.All subjects accepted NIPPV as the initial intervention and they were divided into NIPPV failure group and NIPPV success group according to the requirement of ETI.Univariate analysis and multivariate logistic regression analysis were used to identify the risk factors for NIPPV failure.Receiver operating characteristic(ROC)was plotted to evaluate the predictive value of risk factors for NIPPV failure in these patients.Results:Forty three patients were studied in this experiment.The result shows that the success rate of NIPPV is 62.8%(27/43),and the failure rate is 37.2%(16/43).Compared with the successful group,the incidence of nosocomial infection[44%(7/16)vs 0(0/27),?~2=11.082,P<0.05]and mortality rate[50%(8/16)vs 7%(2/27),?~2=7.965,P<0.05]are significantly increased in the failure group.The univariate analysis indicates that the acute physiology and chronic health evaluation II(APACHE?)score,the ratio of early concurrent bacterial or fungal infections,and the proportion of patients with insufficient NIPPV at the early 72hours are significantly higher in failure group(all P<0.05).Meanwhile,multivariate Logistic regression analysis identifies that the base-line APACHE?score[odds ratio(OR)=1.941,95%confidence internal(95%CI)=1.159-3.249,P=0.012],the rate of early concurrent bacterial or fungal infections[OR=8.602,95%CI=1.267-58.416,P=0.028],and insufficient use of NIPPV at the early 72 hours[OR=10.06,95%CI=1.592-63.527,P=0.014]are independent risk factors associated with NIPPV failure.The ROC curve shows the area under curve(AUC),the sensitivity,and the specificity is 0.748,62.5%,and74.1%respectively,which demonstrates that that APACHE?score at admission is the most predictive factor of NIPPV failure.For the observed indicator without enough NIPPV treatment within 72 hours,the AUC,the sensitivity,and the specificity is 0.714,68.8%,and 74.1%,respectively.And for the observed indicator with concurrent bacterial or fungal infections,the AUC,the sensitivity and the specificity is 0.707,56.3%and85.2%,respectively.Conclusion:Therefore,early use of enough NIPPV in patients with ARDS caused by viral pneumonia can significantly decrease the rate of ETI and mortality.However,NIPPV should not be conducted in patients suffered from severe ARDS or early concurrent bacterial or fungal infections.