评估腹膜功能障碍和预测非侵入性通风失败在慢性阻塞性肺病的急性恶化在印度
Nupur B Patel1, Gaurav Jain1, Udit Chauhan2
1Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Acute and critical care
|June 14, 2023
概括
在开始非侵入性通风治疗 (NIV) 后2小时评估的隔膜功能障碍 (DD) 是慢性阻塞性肺病 (AECOPD) 患者急性恶化中NIV失败的强有力的预测因素. 这种早期评估提供了比基线测量更好的诊断准确度.
科学领域:
- 关键护理医学 关键护理医学
- 肺部医学 肺部医学
- 医疗成像医学成像
背景情况:
- 在患有慢性阻塞性肺病 (AECOPD) 急性恶化患者的基线腹膜功能障碍 (DD) 与在非侵入性通风 (NIV) 期间增加输管需求相关.
- 早期识别可能导致NIV失败的患者对于及时干预和改善结果至关重要.
研究的目的:
- 评估在启动非侵入性通风 (NIV) 2小时后检测到的隔膜功能障碍 (DD) 在预测AECOPD患者中NIV失败的有用性.
- 为了比较DD评估在2小时后的预测性能与基线.
主要方法:
- 60名AECOPD患者的前性队列研究在NIV.上启动.
- 在基线 (T1) 和NIV启动后2小时 (T2) 评估的隔膜功能障碍 (DD) 使用超声波评估隔膜厚度 (ΔTDI) 的变化.
- 由预定义的标准 (PC, ΔTDI <20%) 和预测NIV故障的计算标准 (CC) 定义的DD.
主要成果:
- 在32名患者中发生了NIV衰竭;9人在NIV启动后2小时内发生.
- 在T2 (≤35.3% ΔTDI) 对DD的计算标准 (CC) 切线显示了高灵敏度 (95.65%) 和准确度 (74.51%) 预测NIV失败 (AUC,0.75).
- 与基线标准相比,NIV失败的几率与DD (T2≤35.3%) 相比显著更高.
结论:
- 与基线评估相比,在NIV启动2小时后评估的隔膜功能障碍 (DD) (≤35.3% ΔTDI) 是AECOPD患者NIV失败的优异预测指标.
- 这种早期的基于超声波的评估可以指导临床决定关于持续的NIV支持.
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