重症肺炎合併消化器機能不全患者における早期挿管的機械換気療法の28日間臨床転帰改善効果

To investigate the impact of the timing of invasive mechanical ventilation (IMV) on 28-day clinical outcomes in patients with severe pneumonia (SP) complicated by gastrointestinal dysfunction.

This retrospective study enrolled 104 patients with SP and gastrointestinal dysfunction who received IMV. Based on the time from meeting IMV criteria to its initiation, patients were divided into an Early Group (≤6 hours, n = 52) and a Delayed Group (>6 hours, n = 52). Clinical efficacy, scores [Clinical Pulmonary Infection Score, Acute Physiology and Chronic Health Evaluation II (APACHE II), Gastrointestinal Dysfunction Score (GIDS)], inflammatory markers [C-reactive protein (CRP), Tumor necrosis factor-α (TNF-α), Procalcitonin (PCT)], blood gas parameters [Oxygenation index (PaO₂/FiO₂) and Arterial partial pressure of oxygen (PaO₂)], gastrointestinal function, and prognosis were compared.

The total effective rate was significantly higher in the Early Group (86.54%) than that in the Delayed Group (76.92%) (P<0.05). Intergroup comparisons at 48 and 72 hours post-IMV revealed that the Early Group demonstrated superior improvement in APACHE II scores, GIDS, blood gas parameters, inflammatory markers, and gastrointestinal markers [Gastrin (GAS), Diamine oxidase (DAO)] (all P<0.05). Furthermore, the Early Group had a higher 28-day survival probability, shorter ICU stay and ventilation duration, and a significantly lower overall incidence of adverse reactions (19.23% vs. 53.84%) (P<0.05).

For patients with SP and gastrointestinal dysfunction, early IMV initiation within 6 hours is more effective in mitigating systemic inflammation, improving blood gas exchange and gastrointestinal function, optimizing infection control, reducing adverse events, and ultimately improving clinical prognosis.