用于直管ARDS的延伸倾斜定位:一个审查
Thaïs Walter1, Jean-Damien Ricard2,3
1Université Paris Cité, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, 92700, Colombes, France. thais.walter10@gmail.com.
Critical care (London, England)
|July 5, 2023
概括
在COVID-19患者24小时以后延长易感定位可能通过改善气体交换和减少呼吸机诱导的肺损伤来降低死亡率. 然而,压力损伤等潜在风险需要进一步调查.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 呼吸系统疗法 呼吸系统疗法
背景情况:
- 在COVID-19大流行期间,人们广泛使用倾斜定位,通常延长超过24小时.
- 独立的中心根据临床改善或固定的持续时间采取了扩展的易感定位.
- 最近的一项研究表明,临床驱动的倾斜定位延伸可能会降低死亡率.
研究的目的:
- 在重症患者中,在24小时以后延长倾斜定位的好处和风险的审查.
- 讨论长时间躺卧的患者层面和组织优势.
- 突出需要对扩展的倾斜定位协议进行前性评估.
主要方法:
- 审查现有的文献和中心实践,关于在COVID-19大流行期间延长容易定位.
- 分析患者层面的生理效益,包括气体-组织比率和过度存在.
- 组织效益的评估,例如减少医疗保健工作人员的工作量和减少意外移除设备.
主要成果:
- 延长的俯卧位置可以保持均的气体-组织分布,延迟卧卧位置诱导的过度伸缩.
- 组织效益包括减少员工工作量,减少导管/管道切除的发生率.
- 确定的主要风险是压力损伤的发病率增加,尽管追溯数据令人放心.
结论:
- 延长易受影响的定位超过24小时,在重症监护机构提供潜在的患者和组织利益.
- 需要进一步的前性研究来证实长时间躺卧的安全性和有效性,并减轻压力损伤等风险.
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