大手手術を受けた患者の術後肺合併症に対する手術中の低潮量と通常の潮量による影響: ランダム化臨床試験
Dharshi Karalapillai1,2, Laurence Weinberg1, Philip Peyton1
1Department of Anesthesia, Austin Hospital, Melbourne, Victoria, Australia.
JAMA
|September 2, 2020
まとめ
大手術中の低潮量換気は,従来の換気と比較して,術後の肺合併症を軽減しませんでした. この発見は,現在の換気戦略が短期的に患者のアウトカムを大幅に変化させないことを示唆しています.
科学分野:
- 麻酔科
- クリティカル ケア 医療
- 胸部 外科
背景:
- 機械的な換気は大きな手術の際に不可欠ですが,最適な潮流量設定は議論の余地があります.
- 手術後の肺合併症 (PPC) は重要な懸念事項であり,患者の回復と医療費に影響します.
研究 の 目的:
- 大規模な非心胸内外科手術において,低潮量換気が従来の潮量換気と比較してPPCを減少させるかどうかを調査する.
- 死率と滞在期間を含む様々な二次結果に対する潮量の影響を評価する.
主な方法:
- 単一センターでのランダム化臨床試験で 1236人の大人の患者が 重度の手術を受けています
- 患者は低潮量 (予測体重6mL/ kg) または従来の潮量 (予測体重10mL/ kg) と一貫した陽性終息圧 (PEEP) に割り当てられました.
主要な成果:
- 7日以内のPPCの複合体である主要なアウトカムは,低潮量群の38%と通常の潮量群の39%で発生した (リスク比0. 97; P=.64).
- 2つのグループ間の主要な結果や二次的な結果において,有意な差異は認められなかった.
結論:
- 低潮量換気は,従来の潮量換気と比較して,大手術を受けた成人の患者の肺合併症を有意に減少させませんでした.
- これらの発見は,この手術集団におけるPPCを防ぐために,潮の量を最適化だけでは不十分であることを示唆しています.
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