在急性肺损伤患者中低剂量吸入氧化:随机对照试验
Robert W Taylor1, Janice L Zimmerman, R Phillip Dellinger
1Critical Care Medicine, St Louis University/St John's Mercy Medical Center, St Louis, Mo, USA.
JAMA
|April 8, 2004
概括
低剂量吸入的氧化在急性肺损伤患者中改善了氧化,但没有显著增加机械通风休息日或降低死亡率.
科学领域:
- 关键护理医学 关键护理医学
- 肺部医学 肺部医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 吸入的氧化 (iNO) 已经证明有潜力改善急性肺损伤 (ALI) 患者的氧化.
- 需要进一步研究以确定低剂量iNO在该患者群体中的临床疗效.
研究的目的:
- 评估低剂量 (百万分之五) 吸入氧化在被诊断患有急性肺损伤的患者的临床疗效.
- 评估iNO对呼吸器支持续时间和死亡率的影响.
主要方法:
- 一项多中心,三盲,随机,安慰剂控制的研究在46家美国医院的重症监护病房中进行.
- 385名中度严重的ALI患者 (PaO2 / FiO2比率≤250),不包括败血症引起的损伤,随机分配给接受安慰剂 () 或5ppmiNO.
- 主要终点是活着的日子和关闭机械通风,次要结果包括死亡率和氧化标准用于输出管.
主要成果:
- 吸入5ppm的氧化并没有显著增加患者活着和关闭机械通风的天数 (10.7 vs 10.6天;P=.97).
- 虽然观察到PaO2的短暂增加,但iNO和安慰剂组之间的死亡率相似 (23%对20%;P=.54).
- 在活着几天满足输出管的标准或在成功通风试验后活着几天没有发现显著差异.
结论:
- 低剂量 (5 ppm) 的吸入氧化在精选的急性肺损伤患者中提供短期的氧化效益,但不会显著改善机械通风的持续时间或降低死亡率.
- 这些发现表明,5 ppm iNO在改善ALI患者没有败血症和显著非肺器官功能障碍的结果方面没有临床有效性.
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