在侵入性机械通风期间的压力预防
Deborah Cook1, Adam Deane1, François Lauzier1
1From From the Departments of Medicine (D.C., G.G., W.A., M.M., E.D., J.C.D., J.L.Y.T., B. Rochwerg, T.K.), Health Research Methods, Evidence, and Impact (D.C., N.Z., G.G., D.H.-A., G.R., W.A., M.M., L.H., F.C., J.C.D., B. Rochwerg, F.X., L.T.), and Family Medicine (M.V.), McMaster University, Hamilton, ON, the Department of Medicine, University of British Columbia, Vancouver, BC (B.D.), Population Health and Optimal Health Practice Research Unit, Centre Hospitalier Universitaire de Québec, Université Laval Research Center, Quebec, QC (F. Lauzier), St. Joseph's Healthcare Hamilton Research Institute, Hamilton, ON (D.C., F.C., G.G., L.S., L.T., N.Z.), Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto (J. Marshall, K.B., A. Goffi, M.E.W., R.F., N.K.J.A., S.M.); Queen's University, Kingston, ON (J. Muscedere), the Department of Medicine, Critical Care, University of Ottawa, Ottawa (S.E.), Dalhousie University, Halifax, NS (R.H., O.L.), Niagara Health, St. Catharines, ON (E.D., J.L.Y.T.), Université de Sherbrooke, Sherbrooke, QC (F. Lamontagne, F.D., C.S.A.), Brantford General Hospital, Brantford, ON (B. Reeve), North York General Hospital, Toronto (A. Geagea), the Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB (D.N., K.F.), the University of Manitoba, Winnipeg (G.V.-G., R.Z.), Royal Jubilee Hospital, Victoria, BC (D.O., G.W.), Unity Health Toronto-St. Michael's Hospital, Toronto (K.B., A. Goffi), Vancouver General Hospital, Vancouver, BC (W.H.), Nanaimo Regional General Hospital, Nanaimo, BC (D.F.), the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto (R.F., N.K.J.A.), Western University, London, ON (I.B., T.M.), William Osler Hospital, Brampton, ON (A.B., S.T.), Mount Sinai Hospital, Toronto (S.M.), Cambridge Memorial Hospital, Cambridge, ON (I.M.), Centre Hospitalier de l'Université de Montréal (E.C.) and Hôpital du Sacré-Coeur de Montréal (E.C., Y.A.C.), University of Montreal (D.W.), Montreal, Université Laval, Quebec, QC (P.A.), the Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (O.G.R., V.L.), Meakins-Christie Laboratories and Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre (A.S.K.), and the Department of Critical Care, McGill University (A.S.K., K.K.), Montreal, the Ottawa Hospital Research Institute, Ottawa (S. Kanji), the Department of Medicine, University of Saskatchewan, and the Department of Critical Care, Saskatchewan Health Authority, Regina (E.S.), Royal Columbia Hospital, New Westminster, BC (S.R.), Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Hôpital Maisonneuve-Rosemont, Montreal (F.M.), Université Laval, Faculté de Médecine, Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (F. Lellouche), the Department of Medicine, Windsor Regional Hospital, Windsor, ON (A.R.), Grand River Hospital, Kitchener, ON (P.H.), St. Joseph's Hospital, Toronto (R.C.), St. John Regional Hospital, St. John, NB (M.T.) - all in Canada; the University of Melbourne, Melbourne, VIC (A.D.); the George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales (M.H., J. Myburgh, S. Knowles, N.H., B.V., D.R., L.B., S.F.) and St. George Hospital (J. Myburgh), Sydney, Royal Melbourne Hospital, Melbourne, VIC (K.M.B.), and the University of Adelaide, Adelaide, SA (M.C., A.P.) - all in Australia; King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (Y.M.A.); King's College London (M.O.) and School of Public Health, Faculty of Medicine, Imperial College (S.F.), London; Medical Research Institute of New Zealand, Wellington, New Zealand (P.Y.); the Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Kuwait Extracorporeal Life Support Program, Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait (A.A.-F.); Pontifical Catholic University, Belo Horizonte, Brazil (G.R.); the University of Nebraska Medical Center, Omaha (D.J.); the Department of Pulmonary and Critical Care Medicine, Maroof International Hospital, Islamabad, Pakistan (M.I.); and Midwestern University, College of Pharmacy, Glendale, AZ (J.F.B.).
像潘托普拉这样的质子抑制剂显著降低了重病,通风患者的上部胃肠道出血. 这项研究没有发现对整体死亡率有重大影响,这表明压力预防有好处.
科学领域:
- 关键护理医学 关键护理医学
- 胃肠病学 胃肠病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 质子抑制剂 (PPI) 在需要侵入性通风的危重病患者的压力预防中的有效性和安全性仍然不确定.
- 目前的指导方针没有提供最终的建议,因为有相互矛盾的证据.
研究的目的:
- 评价 pantoprazole 在预防临床上重要的上部胃肠道出血的有效性,在侵袭性通风的危急病人成年人.
- 评估潘托普拉对90天全因死亡率和其他安全结果的影响.
主要方法:
- 一个国际的,随机的,安慰剂对照试验,涉及4821名患病危急的成年患者接受侵入性通风.
- 患者接受了静脉注射的潘托普拉 (40毫克每天) 或与之匹配的安慰剂.
- 主要结局包括临床重要的上部胃肠道出血和90天全因死亡率;次要结局包括呼吸器相关的肺炎和Clostridioides difficile感染.
主要成果:
- 与安慰剂相比,潘托普拉显著降低了临床重要上部胃肠道出血的风险 (1.0%与3.5%相比;危险比,0.30;P<0.001).
- 潘托普拉和安慰剂组之间90天全因死亡率没有显著差异 (29.1%与30.9%;危险比,0.94;P=0.25).
- 潘托普拉也减少了患者重要的出血,而其他次要结果在不同组之间是相似的.
结论:
- 静脉注射潘托普拉可显著降低临床重要上部胃肠道出血的风险在侵袭性通风的危急病患者.
- 潘托普拉在该患者群体中对90天死亡率没有显著影响.
- 这些发现支持在这个高危人群中使用潘托普拉来预防压力,平衡出血风险降低与死亡率中立.
更多相关视频
09:36Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device
Published on: September 24, 2020
07:51Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs
Published on: May 21, 2019
相关概念视频
Peptic Ulcer Disease IV: Management
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current...
Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease
Drugs for Peptic Ulcer Disease: Prostaglandin Analogs as Mucosal Protective Agents
Non-steroidal anti-inflammatory drugs (NSAIDs) can induce peptic ulcers by inhibiting cyclooxygenase, decreasing...
Pathophysiology of Peptic Ulcer Disease: Mucosal Defense Factors
Drugs for Peptic Ulcer Disease: Sucralfate as Mucosal Protective Agents
In this scenario, mucosal protective agents like sucralfate play an essential role. Sucralfate, a complex of sulfated sucrose and aluminum hydroxide, demonstrates its usefulness in acidic conditions,...
Peptic Ulcer Disease I: Introduction
An acute ulcer, marked by superficial erosion and minimal inflammation, swiftly resolves upon identifying and addressing the underlying cause. In contrast, a chronic ulcer persists, potentially eroding through the muscular wall and forming fibrous tissue.
Peptic ulcers can also be...
