在接受CPAP治疗的COVID-19患者中,肺部超声波引导的PEEP定位
Giorgio Bosso1, Gennaro Sansone1, Martina Papillo1
1Department of Emergency Medicine, COVID Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy.
概括
以肺超声波为指导的个性化阳性末尾呼吸压力 (PEEP) 在持续阳性气道压力 (CPAP) 的COVID-19患者中降低了死亡率. 与固定PEEP相比,这种方法改善了氧化和减少了并发症.
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
- 传染性疾病 传染性疾病
背景情况:
- 持续正气道压力 (CPAP) 越来越多地用于COVID-19患有缺血性呼吸衰竭的患者.
- 优化正极呼气压 (PEEP) 对于改善氧化和患者的治疗结果至关重要.
研究的目的:
- 在需要CPAP的COVID-19患者中,比较个性化PEEP与标准固定PEEP的临床效果.
- 评估肺部超声波引导的PEEP定位方法对死亡率和氧化量的影响.
主要方法:
- 一项前性随机临床研究,涉及63名COVID-19患有低血量呼吸衰竭的患者.
- 随机分配患者接受CPAP,使用固定PEEP (10cmH2O) 或通过"PEEP试验"确定个性化的PEEP,使用肺超声波来识别"肺脉".
- 主要结局:住院死亡率+输管治疗的组合. 二次结果:增加PaO2/FiO2比率. 安全指标:肺胸病发病率.
主要成果:
- 与固定PEEP组 (A组) (53.1%) (p<0.01) 相比,个性化PEEP组 (B组) 的死亡率明显较低 (19.3%).
- 个性化PEEP组的PaO2/FiO2 (34.9%) 增加更大,而固定PEEP组 (13.1%) 的增加更大 (p<0.01).
- 在个性化PEEP组中没有报告肺胸病例,而在固定PEEP组中发生了5起.
结论:
- 肺超声指导的个性化PEEP定位与CPAP治疗的COVID-19患者的死亡率降低有关.
- 这种方法有效地改善了氧化,并降低了诸如肺胸炎等并发症的发生率.
- 个性化PEEP优化是管理COVID-19中缺血性呼吸衰竭的一个有价值的策略.
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