在接受连续置换疗法的败血症患者中进行顺序呼吸支:基于MIMIC-III数据库的研究
Chunxia Wang1,2,3, Jianli Zheng4, Yilin Zhao1,2
1Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, 200062, Shanghai, China.
Heliyon
|March 25, 2024
概括
在接受连续脏替代疗法 (CRRT) 的败血症患者中,连续呼吸支 (SRS) 与减少医院死亡率有关. 与直接机械通风相比,SRS的早期应用,首先是氧疗法,然后是机械通风,改善了结果.
科学领域:
- 临界护理医学 临界护理医学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 有效的氧气和血液动力学管理对于败血症患者至关重要.
- 需要持续置换疗法 (CRRT) 的败血症患者往往需要呼吸支持.
- 这种人群的最佳时间和呼吸辅助方法尚未完全理解.
研究的目的:
- 研究在接受CRRT的败血症患者中应用顺序呼吸辅助 (SRS) 的应用.
- 分析这些重症患者中SRS和医院死亡率之间的关联.
主要方法:
- 从MIMIC-III v1.4数据库中对接受CRRT的败血症患者在ICU入院后24小时内进行回顾性分析.
- SRS定义为初始氧气疗法,然后在ICU入院后24小时内进行机械通风 (MV).
- 倾向性得分匹配 (PSM) 和逻辑回归模型被用于比较结果并评估SRS对医院死亡率的影响.
主要成果:
- 多变量逻辑回归表明SRS与较低的医院死亡风险有关.
- 在PSM之后,SRS组的医院死亡率明显较低 (19.4%),与非SRS组 (83.3%) 相比.
- 年龄,qSOFA评分和血管压缩剂使用等因素与接受CRRT和SRS的败血症患者的医院死亡率相关.
结论:
- 在接受CRRT的败血症患者中,SRS的早期应用 (在ICU入院24小时内) 独立地与减少住院死亡率有关.
- 患者直接接受机械通风,没有先前的SRS表现出死亡的高风险.
- 对于需要CRRT的败血症患者来说,SRS代表了一个潜在的有益的呼吸道管理策略.
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