在应急部门的低潮量通风应用中存在差异
Michael Self1,2, Brent Kennis3, Andrew Lafree1
1University of California San Diego, Department of Emergency Medicine, San Diego, California.
低潮量通风 (LTVV) 对于ED患者的肺部保护至关重要. 女性性别,肥胖和身高较低与不接受LTVV有关,影响了患者的治疗结果.
科学领域:
- 关键护理医学 关键护理医学
- 肺部医学 肺部医学
- 健康 公平 卫生 公平
背景情况:
- 低潮量通风 (LTVV) 是一个关键的肺部保护策略,涉及使用8mL/kg理想体重的最大潮量.
- 虽然在急诊部 (ED) 启动LTVV与更好的结果有关,但其应用显示了差异.
- 这项研究调查了ED中LTVV率和患者人口统计学/身体特征之间的关联.
研究的目的:
- 评估人口和物理特征是否影响ED中LTVV的应用.
- 确定与接受非LTVV相关的患者因素,可能阻碍肺保护性通风目标.
- 探索ED LTVV启动对患者结局的影响,包括无住院日.
主要方法:
- 一项回顾性观察队列研究分析了来自1029名需要机械通风的患者在三个ED的数据 (2016年1月至2019年6月).
- 收集了人口统计,机械通风参数和结果 (死亡率,没有住院的日子) 的数据.
- 使用多变量逻辑回归模型来识别与LTVV应用相关的因素.
主要成果:
- 79.5%的患者接受了LTVV,其中81.9%使用了400-500毫升的潮体积.
- 女性性别 (aOR 4.17),肥胖 (aOR 2.27) 和第一四分之一高度 (aOR 12.2) 独立地与接受非LTVV相关.
- 在ED接受LTVV的患者有2.1个无住院日 (P=0.040);没有观察到死亡率差异.
结论:
- 紧急医生通常使用有限的初始潮体积范围,不经常进行调整,可能会损害肺部的保护.
- 女性性别,肥胖和矮身是ED中不接受LTVV的重要独立预测因素.
- 使用ED LTVV与改善无住院日有关,强调其对质量改善和健康公平的重要性.
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