呼吸器比率的下降作为ARDS成年人死亡率的预测者,他们接受了容易的定位
Manuel Tisminetzky1, Bruno L Ferreyro2, Fernando Frutos-Vivar3
1Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Department of Medicine, Division of Respirology, Sinai Health System and University Health Network, Toronto, Ontario, Canada.
在患有急性呼吸困扰综合征 (ARDS) 的患者中,躺卧24小时后呼吸器比率下降与ICU死亡率降低有关. 这一发现可能有助于指导临床医生管理ARDS患者.
科学领域:
- 关键护理医学 关键护理医学
- 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:
- 躺卧是已被证明的干预措施,以减少中度至重度急性呼吸困扰综合征 (ARDS) 患者的死亡率.
- 识别预测对倾斜定位反应的生理参数对于优化患者管理至关重要.
- 目前的研究调查了生理变化的实用性,用于预测ARDS患者接受易受定位的预测结果.
研究的目的:
- 为了确定24小时容易定位和重症监护室 (ICU) 成年ARDS患者的死亡率后生理参数的相对变化之间的关联.
- 确定特定的生理标志物,可以指导临床医生在选择ARDS患者时,可能受益于容易的定位.
主要方法:
- 使用VENTILA数据库的数据进行了队列研究,包括接受易受定位的成年ARDS患者.
- 使用多变量逻辑回归来评估PaO/FIO,动态驾驶压力,PaCO和呼吸器比率与ICU死亡率的相对变化之间的关联.
- 调整后的几率比率 (OR) 与95%的置信区间 (CI) 被报告为关联的措施.
主要成果:
- 该研究包括156名受试者,其中82人 (53%) 经历了ICU死亡率.
- 24小时后呼吸器比率的相对下降与较低的ICU死亡率显著相关 (OR 0.80 [95%CI 0.66-0.97] 每10%下降).
- 在PaO/FIO,PaCO和动态驱动压力中的相对变化与ICU死亡率没有显著关联.
结论:
- 在接受倾斜定位的ARDS患者中,24小时后呼吸器比率的相对下降与ICU死亡风险降低有关.
- 通风比可以作为一个有价值的生理参数来指导在ARDS管理中使用倾斜定位.
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