在没有ARDS的ICU患者中,较低或较高的阳性呼吸压力策略对无呼吸器日的影响:一项随机临床试验
, Anna Geke Algera1, Luigi Pisani1
1Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
JAMA
|December 9, 2020
概括
在没有急性呼吸困扰综合征 (ARDS) 的重症患者中,较低的阳性终端呼吸压力 (PEEP) 与较高的PEEP同样有效. 这项研究发现,较低的PEEP在改善无呼吸器的日子方面没有劣势,支持其在这个患者群体中的使用.
科学领域:
- 危急护理医学
- 呼吸系统生理学
- 临床试验
背景情况:
- 在没有急性呼吸困扰综合征 (ARDS) 的重症患者中,用于侵入性机械呼吸的最佳阳性末尾呼吸压力 (PEEP) 尚不清楚.
- 确定适当的PEEP水平对于患者的治疗结果和重症监护室 (ICU) 的资源利用至关重要.
研究的目的:
- 在没有ARDS的患者中,评估较低的PEEP策略是否与较高的PEEP策略相比,重点是机械呼吸的持续时间.
- 为了比较二次结果,包括死亡率,停留时间和与通风有关的并发症的发展.
主要方法:
- 这是一项非劣势性随机临床试验,涉及980名在荷兰8个重症监护室的无ARDS患者.
- 参与者被随机分配到一个较低的PEEP组 (0 - 5厘米H2O) 或一个较高的PEEP组 (8厘米H2O).
- 主要结局是28日无呼吸器日,非劣势率为-10%.
主要成果:
- 较低的PEEP策略被发现与较高的PEEP策略不相差,平均无呼吸器日分别为18天和17天 (平均比率为1.04;P = .007不相差).
- 在28天死亡率 (38. 4% vs 42. 0%),ICU/住院时间或ARDS,肺炎或肺胸部发病率方面没有发现显著差异.
- 在较低的PEEP组中,严重低氧化和需要救援策略的几率略高,但这些情况没有达到统计学意义.
结论:
- 在没有ARDS的重症患者中,较低的PEEP策略与28日无呼吸器日的较高PEEP策略不相差.
- 这些发现表明,在这种患者群体中可以安全地使用低PEEP,从而可能简化呼吸器管理.
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