系统性倾斜定位在低血症急性呼吸衰竭的影响:一个随机对照试验
Claude Guerin1, Sandrine Gaillard, Stephane Lemasson
1Service de Réanimation Médicale, Hôpital De La Croix-Rousse, Lyon, France. claude.guerin@chu-lyon.fr
JAMA
|November 18, 2004
概括
倾斜的位置并没有改善低血症急性呼吸衰竭 (ARF) 患者的生存率. 然而,这种方法可能会降低ARF患者呼吸器相关肺炎 (VAP) 的发生率.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统医学 呼吸系统医学
- 临床试验 临床试验
背景情况:
- 一项先前的试验表明,在急性肺损伤时,倾斜定位对生存没有益处.
- 对低血症急性呼吸衰竭 (ARF) 倾斜定位的有效性仍然不确定.
研究的目的:
- 调查倾斜位置对急性呼吸衰竭 (ARF) 患者死亡率的影响.
主要方法:
- 这是一项前性,非盲目,多中心的受控试验,涉及791名ARF患者.
- 在机械呼吸过程中,患者被随机分配到俯卧或卧卧的位置.
- 主要终点是28天死亡率;次要终点包括90天死亡率,通风持续时间和VAP发生率.
主要成果:
- 躺着和躺着组之间的28天或90天死亡率没有显著差异.
- 倾斜的位置与明显更高的PaO2/FIO2比率有关.
- 在易受影响的组中观察到压力和内管并发症的发病率增加.
结论:
- 倾斜的定位对低血症ARF患者没有生存益处.
- 倾斜的位置可能会降低呼吸器相关肺炎 (VAP) 的发生率.
- 安全问题,包括压伤,需要考虑躺卧的位置.
更多相关视频
相关概念视频
Physiological Control of Respiration
5.0K
Introduction
Breathing, a seemingly passive process, is regulated by the respiratory center in the brainstem. This center coordinates the involuntary control of respirations, which means it occurs without conscious effort, ensuring a smooth and uninterrupted pattern.
Regulation of Ventilation
The body maintains ventilation by monitoring levels of carbon dioxide (CO2), oxygen (O2), and hydrogen ion concentration (pH) in the arterial blood. Among these factors, the level of CO2 plays a crucial...
Breathing, a seemingly passive process, is regulated by the respiratory center in the brainstem. This center coordinates the involuntary control of respirations, which means it occurs without conscious effort, ensuring a smooth and uninterrupted pattern.
Regulation of Ventilation
The body maintains ventilation by monitoring levels of carbon dioxide (CO2), oxygen (O2), and hydrogen ion concentration (pH) in the arterial blood. Among these factors, the level of CO2 plays a crucial...
5.0K
Respiratory Assessment: Purpose and Indications
2.1K
Respiratory assessment is a cornerstone of nursing assessments, crucial for the early detection of patient deterioration. This evaluation transcends routine procedures, representing a critical skill nurses must master to ensure optimal patient care.
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
2.1K
Acute Respiratory Failure-II
1.8K
Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
1.8K
Acute Respiratory Failure-III
1.3K
Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without...
1.3K
Acute Respiratory Failure-IV
824
Respiratory failure can manifest suddenly or gradually, characterized by a rapid decline in PaO2 and a rapid rise in PaCO2. This situation indicates a severe respiratory problem that may quickly become a life-threatening emergency. One of the early signs of hypoxemic Acute Respiratory Failure (ARF) is a change in mental status due to the brain's sensitivity to oxygen levels and changes in acid-base balance. Symptoms such as restlessness, confusion, and agitation suggest inadequate oxygen...
824
Acute Respiratory Failure-V
768
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
768


