中程度から重度の急性呼吸困難症候群の患者における横たわる姿勢:ランダム化制御試験
Paolo Taccone1, Antonio Pesenti, Roberto Latini
1Dipartimento di Anestesia e Rianimazione, Fondazione IRCCS-Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena di Milano, 20122 Milan, Italy.
JAMA
|November 12, 2009
まとめ
横たわる姿勢は,中度または重度の急性呼吸困難症候群 (ARDS) の患者の生存率を改善しませんでした. このランダム化試験では,罹患傾向のあるグループの28日または6ヶ月の死亡率に有意な利点が見つかりませんでした.
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:
- 以前の分析では,横たわる姿勢が,重度の急性呼吸困難症候群 (ARDS) の低酸素症患者の生存率を向上させる可能性があることが示唆されていた.
- Prone-Supine II Studyは,これらの発見をより広範なARDS集団で検証することを目的とした.
- 最適な換気戦略を理解することは,ARDSの結果を改善するために不可欠です.
研究 の 目的:
- 適度から重度の低酸素血症のARDS患者の生存結果を改善する傾向のあるポジショニングの有効性を評価する.
- 機械呼吸器によるARDS患者の死亡率およびその他の臨床結果に対する傾斜位置の影響を評価する.
主な方法:
- 342人の成人ARDS患者を含む多センター,非ブラインド,ランダム化制御試験 (Prone-Supine II研究) でした.
- 患者は中度 (n=192) と重度 (n=150) の低酸素症サブグループに分類されました.
- 参加者は,機械呼吸器で呼吸する際に,横になった状態または横たわっていた状態 (20時間/日) にランダムに割り当てられました.
主要な成果:
- 全体的に,横たわる姿勢は,横たわる姿勢と比較して,28日または6カ月間の全原因死亡率を有意に低下させなかった (28日での32.8%に対して31.0%).
- サブグループ分析では,プロンポジショニングは,28日または6ヶ月で中程度の低酸素血症患者の生存に有意な利点を示さなかった.
- 同様に,重度の低酸素症の患者の場合,横たわる姿勢は,統計的に有意な28日または6ヶ月の死亡率の減少につながらなかった.
結論:
- 毎日20時間,横たわる姿勢は,中程度または重度の低酸素血症のARDS患者の生存に有意な利点を提供していません.
- この研究では,この患者集団における死亡率を改善するために,プロンポジショニングの日常的な使用を支持する証拠は見つかりませんでした.
- より高い合併症率は,生存上の相応の利益なしに,容易なポジショニンググループで観察されました.
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