非侵入性通风与氧气治疗对急性呼吸衰竭免疫受损患者死亡率的影响:随机临床试验
Virginie Lemiale1, Djamel Mokart2, Matthieu Resche-Rigon3
1Saint-Louis University Hospital, Paris, France.
JAMA
|October 8, 2015
概括
早期的非侵入性呼吸并没有改善免疫功能低下的急性呼吸衰竭患者的存活率. 这项研究发现,单靠呼吸和氧气治疗之间28天的死亡率没有显著差异.
科学领域:
- 危急护理医学
- 肺病学
- 免疫功能受损的宿主研究
背景情况:
- 在免疫功能低下的患者中,建议在低血症急性呼吸衰竭 (ARF) 时进行非侵入性呼吸 (NIV).
- 它在减少这一特定患者群体的死亡率方面的有效性仍然不确定.
研究的目的:
- 调查早期NIV是否能改善非超性急性低血压呼吸衰竭的免疫受损患者的存活率.
- 为了比较早期NIV和标准氧气治疗之间的28天死亡率.
主要方法:
- 一项多中心随机试验,涉及374名患有严重免疫缺陷的患者 (84. 7% 患有血液恶性瘤或固体瘤).
- 患者被随机分为接受早期NIV (n=191) 或单独氧气治疗 (n=183).
- 主要结局是28天死亡率;次要结局包括输管率和ICU停留时间.
主要成果:
- 没有观察到28天死亡率的显著差异:NIV组为24. 1%,氧组为27. 3% (P=.47).
- 在不同组中,氧化失败率相似 (38. 2%与NIV相比,氧化疗法为44. 8%,P=. 20).
- 在ICU获得的感染,机械呼吸的持续时间或ICU/住院时间方面没有发现显著差异.
结论:
- 与单独氧气治疗相比,早期NIV并没有降低免疫功能低下的ARF患者的28天死亡率.
- 这项研究受限于缺乏足够的统计数据来确定NIV的有效性.
- 可能需要进一步的研究来澄清NIV在这一群体中的作用.
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