呼吸合规过程对COVID-19患者的死亡率的预后价值vv-ECMO患者
Simon Valentin1,2,3, Mathieu Amalric4,5, Guillaume Granier1
1CHRU de Nancy, Médecine Intensive et Réanimation Brabois, Université de Lorraine, Nancy, France.
Annals of intensive care
|June 21, 2023
概括
在COVID-19的静脉静脉外体膜氧化 (vv-ECMO) 的前10天内,静态呼吸顺应预测了180天的死亡率. 改善的合规性表明这些重症患者的生存结果更好.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统医学 呼吸系统医学
- 心血管医学 心血管医学
背景情况:
- 用v-ECMO治疗的COVID-19相关的ARDS具有很高的死亡率 (>35%).
- 在vv-ECMO注射后缺乏预后因素来指导患者管理.
- 了解早期预测因素对于优化严重COVID-19呼吸衰竭的护理至关重要.
研究的目的:
- 评估vv-ECMO植入后10天内静态呼吸顺应与COVID-19 ARDS患者的180天死亡率之间的关联.
- 确定vv-ECMO.患者的早期预后指标.
- 为临床决策和患者管理策略提供信息.
主要方法:
- 一个多中心的回顾性研究包括122名COVID-19 ARDS患者在vv-ECMO (2020年3月 - 2021年12月).
- 患者使用针对低驾驶压力 (<15 cmH2O) 的超保护性通风进行管理.
- 在vv-ECMO后的前10天分析了静态呼吸合规性,结果是180天死亡率.
主要成果:
- 六个月死亡率为48%.
- 幸存者在最初的10天内表现出更高的服从性 (18至20毫升/厘米H2O),而非幸存者在最初的10天内表现出更低的服从性 (12至10毫升/厘米H2O) (p < 0.0001).
- 多变量考克斯分析确定了年龄,慢性肺病,早期服从和扫气流作为180天死亡率的独立预测因素.
结论:
- 在vv-ECMO的最初10天内静态呼吸顺应的趋势是COVID-19 ARDS中180天死亡率的重要预测因素.
- 这一发现为处理这些复杂病例的重症治疗师提供了有价值的预后信息.
- 早期评估呼吸道合规性可以帮助风险分层和治疗调整.
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