在低风险或中等风险的患者中,侵略性与保守性查和确认性测试及时进行脱管的效果:随机临床试验
Gonzalo Hernández Martínez1,2,3, Patricia Rodriguez4, Jesus Soto5
1Complejo Hospitalario Universitario de Toledo, Toledo, Spain. ghernandezm@telefonica.net.
Intensive care medicine
|February 14, 2024
概括
积极的查结合预防性阳性末尾呼吸压力 (PEEP) 和保守的自发呼吸试验 (SBT) 显著减少了高流鼻管 (HFNC) 治疗患者的输出时间. 这种策略可以实现更快的输出,而不会增加再输入率.
科学领域:
- 临界护理医学 临界护理医学
- 呼吸系统疗法 呼吸系统疗法
- 机械通风机械通风机械通风
背景情况:
- 机械通风对于呼吸衰竭患者至关重要.
- 输出管,即取出呼吸管的过程,需要谨慎管理,以确保患者的安全和康复.
- 优化输出管的策略可以减少通风时间,改善患者的治疗结果.
研究的目的:
- 在需要机械通风的患者中确定实现快速和安全的输出管的最佳策略.
- 为了比较不同组合的查方法,积极的终端呼吸压力 (PEEP) 水平,和自发呼吸试验 (SBTs) 在高流量鼻管 (HFNC) 治疗的患者.
主要方法:
- 一个多中心试验随机选择了884名患有原发性呼吸衰竭和低至中等风险的输出失败的患者.
- 患者接受了计划的高流量鼻腔管 (HFNC) 预防性治疗.
- 根据查攻击性 (PaO2 / FiO2比率值),PEEP水平和SBT压力支设置,对四组进行了比较.
主要成果:
- 由于安全问题,侵略性-侵略性组的随机化被提前停止.
- 在采用积极查的组中,输出器的中位时间明显较短 (p < 0.001).
- 简单的断奶率各不相同,攻击性-保守性组显示71.65%,而攻击性-攻击性组显示91%. 在不同组中,再灌输率没有显著差异 (p = 0.431).
结论:
- 将积极的查与预防性PEEP和保守的SBT相结合,是一种有效的策略,可以在HFNC患者中实现更快的输出.
- 这种方法可以通过增加再灌输率来减少输出管的时间,而不会损害安全.
- 这些发现为优化在重症监护机构的呼吸机断奶协议提供了宝贵的见解.
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