在患有败血症的重症患者中,ARDS的可归因死亡率:一个多中心,回顾性队列研究
Dong-Hui Wang1, Hui-Miao Jia1, Xi Zheng1
1Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China.
BMC pulmonary medicine
|March 4, 2024
概括
急性呼吸困扰综合征 (ARDS) 在败血症患者中显著增加了30天的死亡率,严重的ARDS构成最大的风险. 这项研究量化了在重症监护室的ARDS可归因的死亡率.
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:
- 败血症和急性呼吸困扰综合征 (ARDS) 是普遍存在的,在重症监护室 (ICU) 的严重情况.
- 有限大规模的多中心数据存在于ARDS可归因于败血症患者的死亡率.
- 这项研究解决了知识差距,评估了严重病的败血症个体中与ARDS相关的过度死亡率.
研究的目的:
- 确定诊断为败血症的危急病患者中可归因于ARDS的过度死亡率.
- 分析ARDS严重程度对败血症诊断后30天死亡率的影响.
主要方法:
- 从2014年1月到2015年8月,一项涉及18个中国ICU的前性多中心队列研究.
- 败血症患者在败血症诊断后七天内被分为ARDS和非ARDS组.
- 倾向性得分匹配 (PSM) 用于1:1患者匹配,随后进行生存分析以评估30天死亡率.
主要成果:
- 在2323名符合条件的败血症患者中,67.8%患有ARDS. 在PSM后,737名ARDS患者与737名非ARDS对照进行了匹配.
- 对ARDS的30天总体可归因死亡率为11.9% (p < 0.001).
- 轻度,中度和严重ARDS的死亡率分别为10.5%,11.6%和18.1%. 在所有严重程度上,ARDS独立增加了30天死亡风险.
结论:
- 在重症败血症患者中,ARDS对30天死亡率有显著的贡献,总体可归因死亡率为11.9%.
- 与轻度和中度形式相比,严重的ARDS显示出更高的可归因死亡率.
- 这些发现证实了ARDS与败血症30天死亡率增加之间存在显著的关联.
相关概念视频
Acute Respiratory Failure-II
223
Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
223
Acute Respiratory Failure-I
206
Acute respiratory failure is a condition characterized by the inability of the lungs to perform their primary function: gas exchange. This failure leads to insufficient oxygen levels (hypoxemia) in the blood, elevated carbon dioxide levels (hypercapnia), or both, causing critical impairment in organ function.
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
206
Acute Respiratory Failure-IV
156
Respiratory failure can manifest suddenly or gradually, characterized by a rapid decline in PaO2 and a rapid rise in PaCO2. This situation indicates a severe respiratory problem that may quickly become a life-threatening emergency. One of the early signs of hypoxemic Acute Respiratory Failure (ARF) is a change in mental status due to the brain's sensitivity to oxygen levels and changes in acid-base balance. Symptoms such as restlessness, confusion, and agitation suggest inadequate oxygen...
156
Acute Respiratory Failure-V
138
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
138
Acute Respiratory Failure-III
184
Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without...
184


