小儿急性呼吸困扰综合征的肺保护性通风:非随机对照试验
Judith Ju Ming Wong1,2, Hongxing Dang3,4, Chin Seng Gan5
1Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore.
Critical care medicine
|June 26, 2024
概括
在儿科急性呼吸窘迫综合征 (PARDS) 中,对肺保护性机械通风 (LPMV) 的坚持至关重要. 虽然LPMV协议没有直接降低死亡率,但遵守其关键元素显著降低了PARDS患者死亡风险.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 呼吸系统生理学 呼吸系统生理学
- 机械通风机械通风机械通风
背景情况:
- 肺部保护性机械通风 (LPMV) 建议用于儿科急性呼吸困扰综合征 (PARDS),但缺乏可靠的数据,并显示可变的坚持.
- 临床实践经常偏离推的LPMV策略,可能会影响患者的治疗结果.
研究的目的:
- 评估LPMV协议与标准护理对患有PARDS的儿科患者死亡率的影响.
- 评估特定LPMV元素的坚持与PARDS中的死亡率之间的关联.
主要方法:
- 在21个儿科重症监护室 (PICU) 进行了一项多中心前后前性研究.
- 包括符合2015年儿童急性肺损伤共识会议PARDS标准并需要侵入性机械通风的患者.
- 在LPMV协议中,包含了最高吸入压力 (PIP),驱动压力 (DP),潮体积,PEEP/FiO2组合,允许的高碳度和保守的氧气目标的限制.
主要成果:
- 在LPMV协议组 (22.8%) 和非LPMV组 (28.3%) 之间没有观察到60天死亡率的显著差异.
- 与非LPMV组相比,LPMV组的遵守LPMV协议显著改善 (57.1比47.6).
- 经过对混因素进行调整后,更高的LPMV策略坚持与60天死亡风险降低有关 (aHR,0.98;P = 0.004),特别是对PIP,DP和PEEP/FiO2设置的坚持.
结论:
- 在PARDS的最初一周内坚持特定的肺部保护机械通风元件与死亡率的降低有关.
- 虽然LPMV协议本身没有显示出直接的死亡率益处,但改善其组件的实施和遵守对于更好的患者结果至关重要.
- 需要进一步的研究和战略,以加强在PARDS管理的临床实践中对LPMV的实施和遵守.
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