在单肺通风过程中个性化,外科手术期间的开放肺通风策略 (iPROVE-OLV):多中心,随机,受控的临床试验
Carlos Ferrando1, Albert Carramiñana2, Patricia Piñeiro3
1Institut D'investigació August Pi I Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
The Lancet. Respiratory medicine
|December 8, 2023
概括
与标准通风相比,个性化开放肺方法 (iOLA) 通风显著减少了肺切除患者手术后严重的肺并发症. 这种方法为胸部手术患者提供了更安全的策略.
科学领域:
- 胸部外科手术 胸部外科手术
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
背景情况:
- 关于个性化开放肺方法 (iOLA) 通风在减少肺切除后的术后肺并发症的有效性存在不确定性.
- 在经过胸部手术需要单肺通风的患者中,对外术期间的IOLA和标准的肺保护性通风进行了比较.
研究的目的:
- 评估个性化开放肺部方法 (iOLA) 的通风策略是否能减少肺切除患者手术后严重的肺部并发症.
- 为了比较iOLA与胸部外科手术中标准肺保护性通风的疗效.
主要方法:
- 一个多中心,随机对照试验,涉及1308名患者接受胸部手术,使用单肺通风.
- 患者被随机分配到iOLA (包括气膜招募机动和个性化PEEP) 或标准肺保护性通风 (手术内PEEP和常规氧气疗法).
- 主要结局是7天内出现严重的术后肺部并发症的综合结果,根据治疗意图进行分析.
主要成果:
- 在IOLA组中,经历严重术后肺部并发症的患者比例明显低于标准通风组 (15%),而在IOLA组 (6%) 的患者比例明显低于标准通风组 (15%).
- 这代表了0.39 (95% CI 0.28至0.56) 的严重并发症的相对风险.
- 与招募操作相关的不良事件很少发生,仅发生在5名患者中.
结论:
- 个性化开放肺透气方法 (iOLA) 呼吸与在接受单肺透气术进行肺切除的患者中,患上严重的术后肺并发症的风险降低有关.
- 在这个患者群体中,iOLA显示出比传统的肺保护性通风策略具有潜在的益处.
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