急性呼吸不全の免疫低下患者の死亡率に対する非侵襲的換気と酸素療法の効果: ランダム化臨床試験
Virginie Lemiale1, Djamel Mokart2, Matthieu Resche-Rigon3
1Saint-Louis University Hospital, Paris, France.
JAMA
|October 8, 2015
まとめ
早期の非侵襲的換気は,低血圧性急性呼吸器不全の免疫低下患者の生存率を向上させなかった. この研究では,呼吸器治療と酸素治療の間の28日間の死亡率は有意な違いを示さなかった.
科学分野:
- クリティカル ケア 医療
- 肺科
- 免疫不全の宿主に関する研究
背景:
- 非侵襲的呼吸器 (NIV) は,低血圧性急性呼吸器不全 (ARF) の患者で推奨されます.
- この特定の患者グループにおける死亡率の減少における有効性は不明である.
研究 の 目的:
- 早期のNIVが,非ハイパーキャプニック急性低血圧呼吸器不全の免疫低下患者の生存率を改善するかどうかを調査する.
- 早期のNIVと標準の酸素療法による28日間の死亡率を比較する.
主な方法:
- 374人の重症免疫低下患者 (84. 7%) を対象とした多センターランダム化試験.
- 患者は早期のNIV (n=191) または単独の酸素療法 (n=183) にランダムに分けられた.
- 主なアウトカムは28日間の死亡率であり,次要アウトカムには挿管率とICU滞在期間が含まれていた.
主要な成果:
- NIV群では24. 1%,酸素群では27. 3% (P=.47) であった.
- NIVでは38. 2%,酸素療法では44. 8% (P=0. 20) でした.
- ICUで得られた感染,機械呼吸器の持続時間,ICU/入院時間の有意な違いは見つかりませんでした.
結論:
- 早期のNIVは,酸素療法のみと比較して,低血圧のARFを有する免疫低下患者の28日間の死亡率を減少させなかった.
- この研究は,NIVの有効性について決定的に結論付けるのに不十分な統計力によって制限された.
- この集団におけるNIVの役割を明確にするには,さらなる研究が必要である.
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