冠状病毒疾病的核心变暖2019年 接受机械通风的患者:试点研究
Nathaniel P Bonfanti1, Nicholas M Mohr2, David C Willms3
1Department of Emergency Medicine, University of Texas at Southwestern Medical Center, Dallas, Texas, USA.
Therapeutic hypothermia and temperature management
|August 1, 2023
概括
在机械通风中温暖COVID-19患者似乎是安全的,但在这个试点研究中没有显著改善呼吸功能或降低死亡率. 需要进一步的研究来优化温度管理策略,以获得更好的结果.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 生理学 生理学 生理学
背景情况:
- 发烧是败血症的保护性反应,体温升高可能会改善结果.
- 以前的研究表明,发烧性败血症患者的变暖可以降低死亡率.
- 治疗核心变暖在COVID-19重症患者中的作用需要调查.
研究的目的:
- 为了确定核心变暖是否改善了COVID-19的机械通风患者的呼吸系统生理学.
- 评估核心升温是否允许更早地从机械通风中断奶.
- 评估核心变暖对COVID-19患者整体生存的影响.
主要方法:
- 有望的,单站点随机对照试验 (RCT) 涉及19名机械通风COVID-19患者.
- 患者被随机分配到标准护理或通过食道热交换器进行72小时的核心升温,目标最高温度为39.8°C.
- 关键结果包括动脉氧气部分压力与分数吸入氧气 (PaO2/FiO2) 的比率,周期值,ICU和30天死亡率,以及无呼吸机的日子.
主要成果:
- 在标准护理和加热组之间,PaO2/FiO2比率 (197对134),周期值 (30.8对31.4) 或无呼吸器日 (11.9对6.8) 没有显著差异.
- 在ICU,标准护理患者的死亡率为40%,加热患者的死亡率为44%;30天死亡率分别为30%和22% (p=NS).
- 核心升温是可行的,在这个患者群体中看起来是安全的.
结论:
- 机械通风COVID-19患者的核心升温是可行的和安全的.
- 这项试点研究没有证明呼吸系统生理学或生存率有显著改善.
- 多模式温度管理策略可能是必要的,以优化在COVID-19患者中达到发烧范围温度的好处.
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