急性肺損傷患者の低用量吸入窒素酸化物:ランダム化制御試験
Robert W Taylor1, Janice L Zimmerman, R Phillip Dellinger
1Critical Care Medicine, St Louis University/St John's Mercy Medical Center, St Louis, Mo, USA.
JAMA
|April 8, 2004
まとめ
低用量の吸入された酸化窒素は,急性肺損傷患者の酸素供給を改善しましたが,機械呼吸器の休息日を大幅に増加させたり,死亡率を低下させたりしませんでした.
科学分野:
- クリティカルケア・メディシン
- 肺内医学 肺内医学 肺内医学
- 薬理学 薬理学とは
背景:
- 吸入された酸化窒素 (iNO) は,急性肺損傷 (ALI) の患者の酸素化を改善する可能性を示しています.
- この患者集団における低用量のiNOの臨床効果を判断するために,さらなる研究が必要である.
研究 の 目的:
- 急性肺損傷と診断された患者の低用量 (百万分5分) の窒素酸化物を吸入した臨床効果を評価する.
- 呼吸器サポートの持続時間と死亡率に対するiNOの影響を評価する.
主な方法:
- マルチセンター,トリプルブラインド,ランダム化,プラセボ対照試験は,米国の46の病院の集中治療室で行われました.
- 385人の中等重度のALI (PaO2/FiO2比≤250) の患者は,敗血症による損傷を除いて,無作為にプラセボ (窒素) または5ppm iNO.を投与されました.
- 主なエンドポイントは,生きた日数と,機械呼吸器を停止した日数であり,二次的なアウトカムには,エクストゥベーションのための死亡率と酸素化基準が含まれています.
主要な成果:
- 5ppmの吸入された酸化窒素は,患者の生存日数と機械呼吸器を停止した日数を有意に増加させなかった (10.7 vs 10.6日; P=.97).
- PaO2の一時的な増加が観察されたが,iNOとプラセボ群の死亡率は類似した (23%対20%;P=.54).
- エクストベーション基準を満たした生存日数や,成功した換気試験後の生存日数において,有意な差異は認められませんでした.
結論:
- 低用量 (5ppm) の窒素酸化物を吸入すると,特定の急性肺損傷患者の短期的な酸素補給効果が得られるが,機械呼吸器の持続時間を大幅に改善したり,死亡率を低下させたりすることはない.
- この研究結果は,5ppmのiNOが,血症と非肺臓器の重要な機能障害のないALI患者のアウトカムを改善するために臨床的に効果的ではないことを示唆している.
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