低血圧性急性呼吸不全における系統的な横たわる姿勢の効果:ランダム化制御試験
Claude Guerin1, Sandrine Gaillard, Stephane Lemasson
1Service de Réanimation Médicale, Hôpital De La Croix-Rousse, Lyon, France. claude.guerin@chu-lyon.fr
JAMA
|November 18, 2004
まとめ
横たわる姿勢は,低血圧性急性呼吸不全 (ARF) の患者の生存率を改善しませんでした. しかし,この方法は,ARF患者の呼吸器関連肺炎 (VAP) の発生率を減らす可能性があります.
科学分野:
- クリティカルケア・メディシン
- 呼吸器医学とは
- クリニック・トライアル 臨床試験
背景:
- 以前の試験では,急性肺損傷において,横たわった姿勢による生存上の利点がないことが示された.
- 低血圧性急性呼吸器不全 (ARF) に対する横たわる姿勢の有効性は依然として不確実でした.
研究 の 目的:
- 急性呼吸器不全 (ARF) 患者における死亡率に対する横たわる姿勢の影響を調査する.
主な方法:
- 791人のARF患者を対象とした前向きで,盲検されず,多センターでコントロールされた試験です.
- 患者は機械呼吸器の使用中に横または横の位置にランダムに割り当てられました.
- 主要エンドポイントは28日間の死亡率であり,次要エンドポイントは90日間の死亡率,換気期間,およびVAP発生率でした.
主要な成果:
- 28日または90日間の死亡率は,横になったグループと横になったグループの間で有意な差異はありません.
- 横になった状態は,かなり高いPaO2/FIO2比率と関連していました.
- 圧力傷や内管の合併症の発生率が増加し,傾向のあるグループで観察されました.
結論:
- 横たわる姿勢は,低血圧のARF患者にとって生存の利点を提供しません.
- 横になった状態は,呼吸器関連肺炎 (VAP) の発生率を潜在的に減少させる可能性があります.
- 圧力傷を含む安全性に関する懸念は,横たわる姿勢で考慮することを正当化します.
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