在没有ARDS的重症监护室患者中,低潮量与中等潮量策略对无呼吸器日的影响:随机临床试验
, Fabienne D Simonis1, Ary Serpa Neto1,2
1Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands.
JAMA
|October 26, 2018
概括
对于没有ARDS的重症患者,在机械通风期间使用低潮体积与中等潮体积相比没有改善结果. 这项研究没有发现无呼吸器日或死亡率的显著差异.
科学领域:
- 危急护理医学
- 呼吸系统生理学
- 机械通风
背景情况:
- 在没有急性呼吸困难综合征 (ARDS) 的重症患者中,侵入性机械通风的最佳潮体积策略尚不清楚.
- 之前的研究主要集中在ARDS患者群体中,因此在了解非ARDS患者的通风策略方面存在差距.
研究的目的:
- 在不需要ARDS的侵袭性机械通风的患者中,比较低潮量通风策略与中等潮量通风策略的有效性.
- 评估这些策略对关键临床结果的影响,包括无呼吸器日和死亡率.
主要方法:
- 这是一项随机临床试验,涉及6个荷兰重症监护室的961名无ARDS患者.
- 患者被随机分为接受低潮量 (n=477) 或中等潮量 (n=484) 的通风.
- 主要结局是28日无呼吸器生存日数,次要结局包括死亡率和不良事件.
主要成果:
- 低潮量 (21天) 和中等潮量 (21天) 组在28日无呼吸器日数中没有显著差异 (平均差异: -0.27;P=.71).
- 两组之间在重症监护室或住院时间以及28天或90天死亡率上没有统计学意义上的差异.
- 低潮量组和中等潮量组的不良事件发生率相似,包括ARDS,肺炎,严重的骨干脱落和肺胸部.
结论:
- 在没有ARDS的重症患者中,需要长时间的机械通风,低潮量策略与中等潮量策略相比,在无呼吸器日方面没有更大的好处.
- 这些发现表明,目前对ARDS的潮体积建议可能不直接适用于非ARDS重症患者.
- 可能需要进一步的研究来探索替代通风策略或患者小组,这些患者可能会从特定的潮体积设置中受益.
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