Influence Factors for Noninvasive Ventilation Failure in Acute Respiratory Failure with Pneumocystis Jirovecii Pneumonia in Patients without HIV Infection
WANG Ming-ming, SONG Li-qiang, YANG Xue-min, et al
Department of Pulmonary and Critical Care Medicine,Xijing Hospital,Air Force Military Medical University,Xi'an Shaanxi 710032
Abstract：【Objective】To investigate the influencing factors of non-invasive mechanical ventilation (NIV) failure in acute respiratory failure (ARF) patients with non-HIV pneumococcal Jirovecii pneumonia (NH-PJP). 【Methods】Retrospective analysis was performed on all patients with ARF caused by NH-PJP (non-NIV pneumococcal Jirovecii pneumonia) from January 2019 to December 2021 in our hospital. General data,immunosuppressant use,clinical symptoms,laboratory tests,NIV use,length of hospital stay and prognosis were collected to analyze the influencing factors of NIV failure. 【Results】A total of 38 eligible patients were collected in the study and NIV failed in 27 patients (71.05%). At 1 h and 24 h after NIV,the PaO2/FiO2 in NIV failure group was significantly lower than that in NIV success group.The acute physiology and chronic health (APACHEⅡ) score of patients in the NIV failure group was significantly higher than that in the NIV success group. In multivariate analysis showed that APACHEⅡ at the beginning of NIV and PaO2/FiO2 at 24 h after NIV were risk factors for NIV failure.NIV failure was significantly associated with hospital mortality (P<0.05). 【Conclusion】APACHEⅡ score and PaO2/FiO2 at 24 h after NIV might predict NIV failure in NH-PJP patients,and the mortality rate was high in NH-PJP patients with NIV failure.
王明明, 宋立强, 杨学敏, 陈洁, 吴运福. 非HIV肺孢子菌肺炎伴急性呼吸衰竭患者无创机械通气失败的影响因素分析[J]. 医学临床研究, 2023, 40(5): 652-655.
WANG Ming-ming, SONG Li-qiang, YANG Xue-min, et al. Influence Factors for Noninvasive Ventilation Failure in Acute Respiratory Failure with Pneumocystis Jirovecii Pneumonia in Patients without HIV Infection. JOURNAL OF CLINICAL RESEARCH, 2023, 40(5): 652-655.
[1] CATHERINOT E,LANTERNIER F,BOUGNOUX M E,et al. Pneumocystis jirovecii Pneumonia[J].Infect Dis Clin North Am,2010,24(1):107-138.
[2] STERN A,GREEN H,PAUL M,et al. Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients[J].Cochrane Database Syst Rev,2014,2014(10):CD005590.
[3] ANTONELLI M,CONTI G,ROCCO M,et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure[J].N Engl J Med,1998,339(7):429-435.
[4] BIENVENU A L,TRAORE K,PLEKHANOVA I,et al. Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients[J].Int J Infect Dis,2016,46:11-17.
[5] YE W L,TANG N,WEN Y B,et al. Underlying renal insufficiency:the pivotal risk factor for Pneumocystis jirovecii pneumonia in immunosuppressed patients with non-transplant glomerular disease[J].Int Urol Nephrol,2016,48(11):1863-1871.
[6] 王明明,杨学敏.肾移植术后患者肺孢子菌肺炎临床特征分析[J].临床肺科杂志,2020,25(9):1355-1358.
[7] 陈雪影,王琪,徐永健,等. 非人类免疫缺陷病毒感染的肺孢子菌肺炎患者的临床特征[J].医学临床研究,2021,38(3):375-378.
[8] MORRIS A,LUNDGREN J D,MASUR H,et al. Current epidemiology of Pneumocystis pneumonia[J].Emerg Infect Dis,2004,10(10):1713-1720.
[9] FERRER M,ESQUINAS A,LEON M,et al. Noninvasive ventilation in severe hypoxemic respiratory failure:a randomized clinical trial[J].Am J Respir Crit Care Med,2003 ,168(12):1438-1444.
[10] 中华医学会呼吸病学分会呼吸生理与重症监护学组,《中华结核和呼吸杂志》编辑委员会. 无创正压通气临床应用专家共识[J].中华结核和呼吸杂志,2009,32(2):86-98.
[11] LEMIALE V,MOKART D,RESCHE-RIGON M,et al. Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure:a randomized clinical trial[J].JAMA,2015 ,314(16):1711-1719.
[12] MONNET X,VIDAL-PETIOT E,OSMAN D,et al. Critical care management and outcome of severe Pneumocystis pneumonia in patients with and without HIV infection[J].Crit Care,2008,12(1):R28.
[13] RANA S,JENAD H,GAY P C,et al. Failure of non-invasive ventilation in patients with acute lung injury:observational cohort study[J].Crit Care,2006,10(3):R79.
[14] THOMAS C F J R,LIMPER A H. Pneumocystis pneumonia[J].N Engl J Med,2004 ,350(24):2487-2498.
2023, Vol. 40 
