创伤患者的喘息呼吸:西文特随机临床试验
Richard K Albert1, Gregory J Jurkovich2, John Connett3
1Department of Medicine, University of Colorado, Aurora.
JAMA
|October 25, 2023
概括
在创伤患者中,将叹息呼吸添加到机械通风中并没有显著增加无呼吸器日. 然而,叹息被很好地容忍,并显示出改善临床结果的趋势,包括减少死亡率.
科学领域:
- 危急护理医学
- 肺部医学
- 创伤手术
背景情况:
- 机械通风可能会导致肺部损伤,可能会耗尽表面活性剂.
- 在创伤患者中减轻呼吸器引起的肺损伤 (VILI) 的益处尚未得到充分证实.
研究的目的:
- 研究是否将叹息呼吸纳入机械呼吸可以改善创伤患者的临床结果.
- 评估叹息对无呼吸器日和28天死亡率的影响.
主要方法:
- 一个实用,随机的试验涉及524名需要机械通风的创伤患者在15个美国学术中心.
- 患者接受了通常的护理或通常的护理加上叹息 (每6分钟一次) 针对特定的平原压力.
- 在28天的随访期内评估结果,主要终点是无呼吸器日.
主要成果:
- 在喘息组 (18. 4天) 和常规护理组 (16. 1天) 之间,无呼吸器日的中位数没有显著差异 (P=0. 08).
- 与通常治疗组 (17. 6%) 相比,叹息组的28天死亡率较低 (P=0. 05).
- 两组之间没有发现非致命性不良事件的显著差异.
结论:
- 在这个创伤患者队列中,在机械呼吸中添加叹息呼吸并没有显著增加无呼吸器日.
- 发现叹息耐受性良好,并表明改善临床结果的潜在益处,因此需要进一步调查.
更多相关视频
相关概念视频
Mechanical Ventilation II: Invasive Ventilation
160
Ventilators are essential medical equipment used to aid patients with respiratory difficulties. Their primary function is to assist or replace spontaneous breathing by providing mechanical ventilation. There are two general classes of mechanical ventilators: negative-pressure and positive-pressure ventilators.
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
160
Cardiopulmonary Resuscitation II: ACLS Airway Management
16
Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
16
Radiological Investigation II: MRI and Ventilation Perfusion Scan
131
Description
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
131
Assessment of Ventilation I: Respiratory Rate
1.1K
Assessment of Ventilation
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
1.1K
Mechanical Ventilation I: Indication and Settings
416
Mechanical ventilation is a life-saving technique for managing acute respiratory failure and other respiratory complications. The process involves using a machine known as a ventilator to supply oxygen to the lungs and assist in removing carbon dioxide. It serves as a bridge to long-term mechanical ventilation or a temporary measure until ventilatory support is discontinued. The ventilator can maintain this function for a prolonged period, providing critical support for patients until they can...
416
Mechanical Ventilation III: Noninvasive Ventilation
134
Noninvasive positive-pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) are essential methods in respiratory care. These ventilation techniques offer unique benefits for patients with various respiratory conditions, providing adequate support without requiring intubation. Let's explore how each method is crucial in improving patient outcomes and enhancing respiratory therapy.
Noninvasive Positive-Pressure Ventilation...
Noninvasive Positive-Pressure Ventilation...
134


