トラウマ患者における喘息呼吸: SiVent のランダム化臨床試験
Richard K Albert1, Gregory J Jurkovich2, John Connett3
1Department of Medicine, University of Colorado, Aurora.
JAMA
|October 25, 2023
まとめ
呼吸器呼吸を機械呼吸に追加すると,トラウマ患者の呼吸器のない日数が有意に増加しなかった. しかし,うめきはよく耐えており,死亡率の低下を含む改善傾向を示しました.
科学分野:
- クリティカル ケア 医療
- 肺医学
- トラウマ 手術
背景:
- 機械的な換気は恒常的な潮流量による肺損傷を引き起こし,表面活性物質を潜在的に枯渇させる可能性があります.
- トラウマ患者における呼吸器誘発性肺損傷 (VILI) の緩和におけるため息の効果は十分に確立されていません.
研究 の 目的:
- トラウマ患者の臨床結果を改善するかどうかを調査する.
- 呼吸器のない日と28日間の死亡率に対する 喘息の影響を評価する.
主な方法:
- 機械呼吸器が必要な524人のトラウマ患者による 実践的なランダム化試験が 15の米国学術センターで行われました
- 患者は通常のケアまたは通常のケアと息を吸う呼吸 (6分ごとに1回) を受け,特定のプレートプレッシャーをターゲットにしました.
- 結果は28日間のフォローアップ期間で評価され,呼吸器のない日は主要なエンドポイントでした.
主要な成果:
- 呼吸器を使用しなかった日の平均は,喘息群 (18. 4日) と通常治療群 (16. 1日) の間で有意に異なる (P=0. 08).
- 通常の治療群 (17. 6%) と比較して,喘息群で28日間の死亡率が低かった (P=0. 05).
- 致命的でない有害事象の有意な差異は認められなかった.
結論:
- このトラウマ患者のコホートでは,呼吸呼吸を機械呼吸に追加しても,呼吸器を使わない日が有意に増加しなかった.
- 喘息はよく耐えており,臨床結果の改善に役立つ可能性を示唆しており,さらなる調査が必要である.
さらに関連する動画
関連する概念動画
Mechanical Ventilation II: Invasive Ventilation
160
Ventilators are essential medical equipment used to aid patients with respiratory difficulties. Their primary function is to assist or replace spontaneous breathing by providing mechanical ventilation. There are two general classes of mechanical ventilators: negative-pressure and positive-pressure ventilators.
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
160
Cardiopulmonary Resuscitation II: ACLS Airway Management
16
Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
16
Radiological Investigation II: MRI and Ventilation Perfusion Scan
131
Description
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
131
Assessment of Ventilation I: Respiratory Rate
1.1K
Assessment of Ventilation
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
1.1K
Mechanical Ventilation I: Indication and Settings
416
Mechanical ventilation is a life-saving technique for managing acute respiratory failure and other respiratory complications. The process involves using a machine known as a ventilator to supply oxygen to the lungs and assist in removing carbon dioxide. It serves as a bridge to long-term mechanical ventilation or a temporary measure until ventilatory support is discontinued. The ventilator can maintain this function for a prolonged period, providing critical support for patients until they can...
416
Mechanical Ventilation III: Noninvasive Ventilation
134
Noninvasive positive-pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) are essential methods in respiratory care. These ventilation techniques offer unique benefits for patients with various respiratory conditions, providing adequate support without requiring intubation. Let's explore how each method is crucial in improving patient outcomes and enhancing respiratory therapy.
Noninvasive Positive-Pressure Ventilation...
Noninvasive Positive-Pressure Ventilation...
134


