肺动脉导管的使用和心脏重症监护病房的死亡率
Bernard S Kadosh1, David D Berg2, Erin A Bohula2
1Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health, New York, New York, USA; Lenox Hospital, Northwell Health, New York, New York, USA.
JACC. Heart failure
|June 15, 2023
概括
肺动脉导管 (PAC) 的使用在心脏重症监护室 (CICU) 很大不同,受机构因素的影响. 在休克患者中使用PAC与改善生存率有关,但需要更多的试验.
科学领域:
- 心脏病学 心脏病学
- 临界护理医学 临界护理医学
- 临床研究 临床研究
背景情况:
- 肺动脉导管 (PAC) 在危急心脏病患者的临床实用性是持续辩论的主题.
- 目前在心脏重症监护室 (CICU) 使用PAC的现行做法和影响因素需要进一步描述.
研究的目的:
- 分析CICU中PACs的当代使用情况.
- 确定与PAC安置相关的患者层面和机构因素.
- 调查PAC使用与住院死亡率之间的关系.
主要方法:
- 一项涉及2017年至2021年北美重症监护室的多中心研究.
- 数据收集包括连续CICU入院的每年2个月快照.
- 关键数据点包括入院诊断,患者人口统计,PAC利用率和住院死亡率.
主要成果:
- 在13,618例入院病例中,有3,827例患有休克病 (2,583例患有心脏病).
- 机械循环支持和心力衰竭强烈预测了PAC的使用.
- 在各中心观察到PAC使用的显著差异 (8%73%),并未完全由患者因素解释.
- 经过调整后的分析显示,PAC使用与休克患者的死亡率降低有关 (OR:0.79;P = 0.017).
结论:
- 在PAC使用中存在很大的差异,部分原因是制度趋势.
- 在急性心脏病患者中使用PAC与休克相关,有助于改善存活率.
- 随机对照试验对于在心脏重症监护中建立最佳PAC指导方针至关重要.
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