基于COVID-19疾病严重程度和死亡率的输管决定:一项国际研究
Athanasios Chalkias1,2, Yiyuan Huang3, Anis Ismail4
1Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Critical care medicine
|February 23, 2024
概括
根据严重性得分指导的严重COVID-19的早期输管治疗,显著降低了死亡风险. 这项研究强调了危重病患者及时机械通风的重要性.
科学领域:
- 临界护理医学 临界护理医学
- 传染性疾病 传染性疾病
- 呼吸系统医学 呼吸系统医学
背景情况:
- 对于重症COVID-19患者机械通风的最佳时间存在不确定性.
- 基于严重性标准的输管时间可能会影响患者的治疗结果.
研究的目的:
- 评估早期与晚期侵入性机械通风 (EIMV与LIMV) 对严重COVID-19死亡率的影响.
- 评估以严重性标准为指导的输管时间是否会影响30天死亡率.
主要方法:
- 未来的多中心观察性研究 (2020年2月至2022年11月) 涉及4464名需要输管治疗的住院COVID-19患者.
- 患者被分为EIMV (顺序器官衰竭评估 [SOFA] < 7或PaO2/FiO2 > 250) 和LIMV (SOFA ≥ 7和PaO2/FiO2 ≤ 250) 组.
- 使用反向治疗概率权重分析来调整混因素.
主要成果:
- 在854名输管患者中,621人 (72.7%) 接受了EIMV,233人 (27.3%) 接受了LIMV.
- 30天死亡率在EIMV组为42.2%,在LIMV组为46.6% (p=0.28).
- EIMV与30%降低30天死亡风险 (aHR 0.68;p=0.008) 和30%降低输管后死亡风险 (aHR 0.70;p=0.006) 相关.
结论:
- 以客观严重性标准为指导的早期侵入性机械通风策略与严重的COVID-19中较低的死亡率有关.
- 基于客观评估的及时输管治疗对于改善COVID-19重症患者的治疗结果至关重要.
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