ARDS のない重症治療室の患者で,低潮量対中潮量戦略の呼吸器のない日に対する効果: ランダム化臨床試験
, Fabienne D Simonis1, Ary Serpa Neto1,2
1Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands.
JAMA
|October 26, 2018
まとめ
ARDSのない重症患者の場合,機械呼吸器で低潮量を使用すると,中間潮量と比較して結果が改善されませんでした. この研究では,呼吸器のない日数や死亡率の有意な差は認められませんでした.
科学分野:
- クリティカル ケア 医療
- 呼吸器の生理学
- 機械的な換気
背景:
- 急性呼吸障害症候群 (ARDS) のない重症患者の侵入的機械呼吸のための最適な潮量戦略は不明である.
- 以前の研究は主にARDS集団に焦点を当てており,ARDSでない患者のための換気戦略の理解にギャップを残しています.
研究 の 目的:
- 低潮流量換気戦略と中等潮流量換気戦略の有効性を,ARDSのない侵入的機械換気を必要とする患者で比較する.
- 呼吸器のない日数と死亡率を含む主要な臨床結果に対するこれらの戦略の影響を評価する.
主な方法:
- オランダの6つの集中治療室でARDSのない96"人の患者を対象としたランダム化臨床試験です.
- 患者は無作為に,低潮量 (n=477) または中等潮量 (n=484) の換気を受けた.
- 死亡率と有害事象を含む二次的アウトカムで,第28日に生存した呼吸器のない日の数でした.
主要な成果:
- 低潮量 (21日) と中等潮量 (21日) のグループでは,28日目の呼吸器のない日の平均数において有意な差は認められなかった (平均差: - 0. 27; P=.71).
- 集中治療室や入院期間,28日または90日間の死亡率に統計的に有意な違いはありませんでした.
- ARDS,肺炎,重症性アテレクタシス,肺胸炎を含む有害事象の発生率は,低潮量群と中等潮量群の間で類似していました.
結論:
- ARDSのない重症の患者は,長期にわたる機械呼吸器を必要としますが,低潮量戦略は,中間の潮量戦略と比較して,呼吸器のない日の観点から,より大きな利益をもたらしません.
- これらの発見は,ARDSに対する現在の潮量推奨が,非ARDSの重症患者には直接適用できないことを示唆している.
- この集団における特定の潮量設定から恩恵を受ける可能性のある代替換気戦略や患者のサブグループを探るためのさらなる研究が正当化される可能性があります.
関連する概念動画
Clinical Trials
10.5K
Clinical trials are prospective experimental studies conducted on humans to determine the safety and efficacy of treatments, drugs, diet methods, and medical devices. Using statistics in clinical trials enables researchers to derive reasonable and accurate conclusions from the collected data, allowing them to make wise decisions in uncertain situations. In medical research, statistical methods are crucial for preventing errors and bias.
There are four phases in a clinical trial. A phase one...
There are four phases in a clinical trial. A phase one...
10.5K
Clinical Trials: Overview
5.0K
Clinical development focuses on how the drug will interact with the human body and encompasses four key phases of clinical trials, each serving a specific purpose in assessing the safety and effectiveness of new drugs. These phases overlap and build upon one another. Phase I involves a small group of healthy volunteers (typically 20-80 individuals) or, in cases where significant toxicity is expected, patients with the targeted disease, such as cancer or AIDS. The volunteers are tested for...
5.0K
Patient-centered Care
3.0K
Patient-centered care involves delivering care beyond inpatient hospitalization. Reflective practice can enhance a patient-centered approach. Reflective practice is a process of reasoning that considers all aspects of the present situation, including practicalities, learning from personal practice, and consideration of patient needs. Patients appreciate care decisions made while considering their input. Involving the patient in their care provides the patient with a sense of contribution rather...
3.0K
Tidal Forces
3.4K
The origin of Earth's ocean tides has been a subject of continuous investigation for over 2000 years. However, the work of Newton is considered to be the beginning of the proper understanding of the phenomenon. Ocean tides are the result of gravitational tidal forces. These same tidal forces are present in any astronomical body; they are responsible for the internal heat that creates the volcanic activity on Io, one of Jupiter's moons, and the breakup of stars that get too close to...
3.4K
Statistical Software for Data Analysis and Clinical Trials
1.5K
Statistical software is pivotal in data analysis and clinical trials by providing tools to analyze data, draw conclusions, and make predictions. These software packages range from simple data management applications to complex analytical platforms, supporting various statistical tests, models, and simulation techniques. Their significance lies in their ability to handle vast amounts of data with precision and efficiency, enabling researchers to validate hypotheses, identify trends, and make...
1.5K
Measurement: Derived Units
55.5K
The International System of Units or SI system, by international agreement, has fixed measurement units for seven fundamental properties: length, mass, time, temperature, electric current, amount of substance, and luminosity. These are called the SI base units.
55.5K


