在COVID-19患者中,成功与失败的过渡从受控通风到压力支持通风:一项回顾性队列研究
Melisa Polo Friz1,2, Emanuele Rezoagli1,2, Bijan Safaee Fakhr3,4
1School of Medicine and Surgery, University of Milan-Bicocca, Monza, MB, Italy.
Critical care explorations
|February 12, 2024
概括
在COVID-19患者中,PaO2/FiO2比率是控制机械通风 (CMV) 到压力支通风 (PSV) 的成功断奶的唯一独立预测因素. 未能转换为PSV与增加ICU死亡率和更长的住院时间有关.
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:
- 控制式机械通风 (CMV) 对COVID-19呼吸衰竭至关重要.
- 过渡到压力支通风 (PSV) 是恢复的一个关键步骤.
- 这种过渡的预测因素和结果尚未得到充分证实.
研究的目的:
- 确定预测COVID-19患者从CMV成功过渡到PSV的因素.
- 评估这种转变对患者结果的影响.
主要方法:
- 在24个意大利ICU进行了回顾性观察队列研究 (2020年2月至5月).
- 包括机械通风的ICU患者,患有COVID-19引起的呼吸衰竭.
- 被定义为"辅助呼吸失败",即在PSV开始后72小时内恢复CMV.
主要成果:
- 在514名患者中,357人成功过渡到PSV,而157人失败了.
- 过渡前的PaO2/FiO2比率是成功的唯一独立预测因素 (OR 1.00;p=0.003).
- 失败组的ICU死亡率较高 (HR2.08;p<0.001),ICU停留时间较长 (27对21天;p<0.001),机械通风持续时间较长 (24对19天;p=0.04).
结论:
- PaO2/FiO2比率是预测从CMV过渡到PSV过渡失败的唯一独立因素.
- 不成功的过渡与患者的结果明显恶化有关,包括死亡率增加和长时间的ICU停留.
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