トラキア管注入を受けた重症患者の心血管崩壊に対する液体ボルス投与の効果: ランダム化臨床試験
Derek W Russell1,2, Jonathan D Casey3, Kevin W Gibbs4
1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama Heersink School of Medicine, Birmingham.
JAMA
|June 16, 2022
まとめ
トラキア管注入中に重症の成人に静脈注入した液体の注入は,心血管崩壊を有意に減少させなかった. この発見は,この患者集団における低血圧,心停止,または死亡の予防に効果的ではないことを示唆しています.
科学分野:
- クリティカル ケア 医療
- 麻酔科
- 心血管の生理学
背景:
- 低血圧は重症な成人における気管管挿管の際に頻繁に起こる合併症です.
- この合併症は,心臓発作や死亡を含む有害な結果のリスクを高めます.
研究 の 目的:
- 重症な成人における静脈内流体ボルス投与による重度の低血圧,心停止,および気管管挿管中の死亡の予防の有効性を調査する.
主な方法:
- 1067人の重症の成人を対象とした ランダム化臨床試験です
- 参加者はランダムに分けられ,500mLの静脈注射ボルスまたはボルスなしでした.
- 主なアウトカムは血管圧縮剤の使用,低血圧,心停止,または挿管後1時間以内に死亡によって定義された心血管崩壊でした.
主要な成果:
- 流体ボリューム群 (21. 0%) と流体ボリューム群 (18. 2%) の間で心血管崩壊の発生率に有意な差はありません.
- 新規または増加した血管圧縮薬の使用率,重度の低血圧,心停止,および死亡率は,グループ間で類似した.
- 28日間の死亡率 (退院時に検閲された) に関して,液体ボリュス (40. 5%) と液体ボリュス (42. 3%) 群の間で有意な差はなかった.
結論:
- 静脈内流体ボルス投与は,気管管挿管を受けた重症成人における心血管崩壊の発生率を有意に低下させなかった.
- 研究結果は,この処置中の不良血液動力学的イベントを予防するために,定期的な流体ボルス投与が有益でないことを示唆している.
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