急性低血圧性呼吸器不全とCOVID-19の患者における挿管または死亡に対する非侵襲的呼吸器戦略の効果:RECOVERY-RSランダム化臨床試験
Gavin D Perkins1,2, Chen Ji1, Bronwen A Connolly3,4,5,6
1Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, England.
JAMA
|January 24, 2022
まとめ
継続的な陽性呼吸道圧 (CPAP) は,標準的な治療と比較して,COVID-19患者における挿管または死亡率を著しく減少させた. 高フロー鼻酸素 (HFNO) は,これらのアウトカムにおいて従来の酸素療法より有意な効果を示さなかった.
科学分野:
- 肺科
- クリティカル ケア 医療
- 感染症
背景:
- COVID-19患者の急性低血圧性呼吸器不全は,効果的な呼吸器のサポートを必要とします.
- 継続的な正気圧 (CPAP) と高流量鼻酸素 (HFNO) が推奨される非侵襲的な戦略です.
- CPAPとHFNOの比較効果と安全性に関する証拠は限られている.
研究 の 目的:
- 急性低血圧性呼吸器不全の入院COVID-19患者の通常の酸素療法と比較して,CPAPとHFNOの臨床結果を比較する.
- これらの非侵襲的な戦略が気管内置と死亡率に与える影響を評価する.
主な方法:
- COVID-19に関連した急性低血圧性呼吸器不全の1273人の入院者を対象とした並列グループ,適応型,ランダム化臨床試験.
- 患者はランダムにCPAP (n=380),HFNO (n=418) または従来の酸素療法 (n=475) を受けた.
- 主なアウトカムは,気管管内置または30日以内の死亡率の複合でした.
主要な成果:
- 常規の酸素療法と比較して,継続的な陽性気道圧 (CPAP) は,気管挿管または30日間の死亡率の複合結果を有意に減少させた (36. 3% 対 44. 4%,P=. 03).
- 高フロー鼻酸素 (HFNO) は,従来の酸素療法 (44. 3%対45. 1%,P=. 83) と比較して,主要なアウトカムにおいて有意な違いを示さなかった.
- CPAP群では34. 2%,HFNO群では20. 6%,従来の酸素療法群では13. 9%の有害事象が報告されました.
結論:
- 初期CPAP戦略は,急性低血圧呼吸器不全のCOVID-19患者における気管内置または死亡のリスクを大幅に低下させる.
- HFNOと従来の酸素療法では有意な違いは認められなかった.
- 研究の限界には,早期終了,HFNO比較の潜在的不足,および参加者のクロスオーバーが含まれており,慎重な解釈が必要である.
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