慢性呼吸器疾患を有するハイパーカプニック患者のエクスタブション後の非侵襲的換気:ランダム化制御試験
Miquel Ferrer1, Jacobo Sellarés, Mauricio Valencia
1Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain. miferrer@clinic.ub.es
Lancet (London, England)
|August 18, 2009
まとめ
早期の非侵襲的換気は,エクストゥベーション後のハイパーカプニック患者の呼吸不全と90日間の死亡率を著しく減少させた. この効果的な戦略は,慢性呼吸器疾患の通気管患者のために推奨されます.
科学分野:
- クリティカルケア・メディシン
- 呼吸器医学とは
- 肺生理学 肺生理学とは
背景:
- 非侵襲的換気 (NIV) は,高リスクの個体において,エクスチューブ後呼吸不全を予防するために認められています.
- 以前の研究では,NIVを使用したハイパーカプニック患者の生存率の改善が示されました.
- この研究は,エクストゥベーション後のハイパーカプニック患者および救命療法としてのNIVの有効性を前向きに評価しています.
研究 の 目的:
- 抽出後72時間以内に呼吸不全を予防する非侵襲的換気 (NIV) の有効性を評価する.
- エクスチューブ後呼吸不全の救済療法としてのNIVの役割を評価する.
- ハイパーカプニック患者の90日間の死亡率に対するNIVの影響を決定する.
主な方法:
- スペインの3つの集中治療室でランダム化制御試験が行われました.
- 慢性呼吸器疾患と頭蓋多発症の機械呼吸器を施された患者106人が,自発呼吸試験の後に登録されました.
- 参加者は,抽出術後の24時間のNIV (n=54) または従来の酸素療法 (n=52) を受けるようにランダムに割り当てられました.
主要な成果:
- 呼吸不全は,従来の酸素群 (25/48) (p<0.0001) と比較して,NIV群 (8/54) でより頻繁に発生しました.
- 救出療法としてのNIVは,27人の患者のうち17人の患者で再インチューベーションを成功裏に回避しました.
- NIVは,エクスチューベーション後の呼吸器不全のリスク (調整された確率比0.17) と90日間の死亡率の低下 (p=0.0146) と独立して関連していました.
結論:
- 抽出術後の非侵襲的換気の早期適用は,呼吸器不全のリスクを大幅に低下させます.
- NIVの導入は,ハイパーカプニック患者の90日間の死亡率の有意な減少にもつながります.
- NIVの日常的な使用は,慢性呼吸器疾患の機械呼吸器患者の管理に推奨されます.
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