Impact of ARDS Etiology on the Failure of Noninvasive Ventilation and 28-Day Mortality: A Multicenter Prospective Observational Study

作者：Weiwei Shu, Shuliang Guo, Fuxun Yang, Bicui Liu, Zhongxing Zhang, Xiaoyi Liu, Baixu Chen, Tao Huang, Liucun Li, Ke Wang, Dehua He, Qimin Chen, Bilin Wei, Lijuan Chen, Manyun Tang, Guodan Yuan, Min Mao, Zhijun Tang, Fei Ding, Wenpin Ge, Xiaoli Han, Rui Zhang, Lei Jiang, Linfu Bai, Jun Duan · 发表于：Research Square · 年份：2021 · DOI：10.21203/rs.3.rs-220238/v1 · 研究领域：Respiratory Support and Mechanisms、Intensive Care Unit Cognitive Disorders、Cardiac Arrest and Resuscitation

Abstract Background: The failure rate of noninvasive ventilation (NIV) remains high in patients with acute respiratory distress syndrome (ARDS). The etiology of ARDS may play an important role in NIV failure. Methods: A multicenter prospective observational study was performed in 17 ICUs in China from September 2017 to December 2019. ARDS patients who used NIV as a first-line therapy were enrolled. The etiology of ARDS was recorded at study entry. Results: A total of 306 patients were enrolled. Of the patients, 146 were classified as having pulmonary ARDS (ARDSp) and 160 were classified as having extrapulmonary ARDS (ARDSexp). NIV improved PaO 2 /FiO 2 from initiation to 24 h of NIV in both groups. However, it improved more slowly in patients with ARDSp than in those with ARDSexp (interaction effect: p < 0.01). ARDSp patients experienced more NIV failure (55% vs. 28%; p < 0.01) and higher 28-day mortality (47% vs. 14%; p < 0.01). The multivariate Cox regression also showed that ARDSp was independently associated with NIV failure (hazard ratio [HR] = 2.81, 95% confidence interval [CI]: 1.89-4.18) and 28-day mortality (HR = 7.49, 95% CI: 4.32-13.01). After propensity matching, 62 patients remained in each group. The baseline data were comparable between the two groups. ARDSp was still independently associated with NIV failure and 28-day mortality (HR = 2.62, 95%CI: 1.49-4.61; and 5.70, 2.59-12.55, respectively). Sensitivity analysis also confirmed these results. Conclu...