患有急性脑损伤的患者的机械呼吸:通过元分析进行系统性审查
Karim Asehnoune1,2, Paul Rooze3, Chiara Robba4
1Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôtel Dieu, 44093, Nantes, France. karim.asehnoune@chu-nantes.fr.
Critical care (London, England)
|June 6, 2023
概括
像低潮量和PEEP这样的呼吸器策略对急性脑损伤患者的死亡率或ARDS没有影响. 然而,保护性通风改善了氧化,这表明在这个人群中安全使用它.
科学领域:
- 关键护理医学 关键护理医学
- 神经学 神经学
- 呼吸系统医学 呼吸系统医学
背景情况:
- 急性脑损伤 (ABI) 患者通常需要侵入性机械通风 (IMV).
- 对ABI患者的最佳呼吸系统策略仍在争论中,这影响了结果.
- 了解特定的呼吸机设置的影响对于患者管理至关重要.
研究的目的:
- 评估不同呼吸器策略对急性脑损伤患者的死亡率和其他结果的影响.
- 分析低潮水体积,正极呼气压 (PEEP) 和保护性通风的影响.
主要方法:
- 一个系统的审查和个别患者数据的元分析.
- 包括观察和干预研究到2022年8月.
- 分析了5639名患有急性脑损伤的患者的数据,这些患者接受了24小时以上的IMV治疗.
主要成果:
- 对于低潮水量,中度至高PEEP或保护性通风策略,在28天死亡率或住院死亡率中没有发现显著差异.
- 这些策略也没有显著影响急性呼吸困扰综合征 (ARDS) 的发生率.
- 在IMV的前五天内,保护性通风与改善的氧化 (PaO2/FiO2比率) 有关.
结论:
- 目前的保护性呼吸器策略 (低潮量,PEEP,组合) 与ABI患者的死亡率或ARDS发病率的降低无关.
- 防护通风证明了改善氧化的好处,可以安全地实施.
- 需要进一步的研究来准确地定义呼吸器管理在严重脑损伤结果中的作用.
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