在自发呼吸试验中预测输出失败的潮尾二氧化碳:一项前性观察性研究
Faten May1, Nicolas de Prost1, Keyvan Razazi1
1AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010 Créteil, France; Univ Paris Est Créteil, CARMAS, Créteil F-94010, France; Univ Paris Est Créteil, INSERM, IMRB, Créteil F-94010, France.
Journal of critical care
|July 20, 2024
概括
在自发呼吸试验 (SBT) 期间的潮尾二氧化碳 (EtCO2) 监测对预测输出失败 (EF) 的能力有限. 诸如急性呼吸衰竭和无效咳之类的因素是输出管成功的更重要的预测因素.
科学领域:
- 临界护理医学 临界护理医学
- 呼吸系统生理学 呼吸系统生理学
- 肺部病理学 肺部病理学
背景情况:
- 机械通风后的输出失败 (EF) 与患者的不良结果有关.
- 在自发呼吸测试 (SBT) 期间的头顶是EF的已知预测因素,但动脉血液气体 (ABG) 测量不是常规的.
- 潮尾二氧化碳 (EtCO2) 是SBT期间监测的非侵入性替代方案.
研究的目的:
- 评估终潮二氧化碳 (EtCO2) 在预测输出失败 (EF) 中的临床效用.
- 为了确定SBT期间EtCO2水平是否可以识别患有脱失败风险较高的患者.
主要方法:
- 一项前性研究涉及189名患者,在成功的1小时低压支SBT后接受计划的输出管.
- 临床数据和EtCO2水平在SBT之前,期间 (5分钟后) 和结束时被记录下来.
- 使用多变量分析来确定EF的独立预测因子.
主要成果:
- 在SBT*之前测量的EtCO2度在经历EF的患者中显著较低,与成功输出管的患者相比 (p=0.02).
- 在SBT5分钟和SBT结束时测量的EtCO2水平在组之间没有显著差异 (分别为p=0.06和p=0.09).
- 确定EF的独立预测因素是输管 (急性呼吸衰竭) 和无效咳的初始原因.
结论:
- 在成功的SBT期间监测EtCO2似乎对输出失败的预测价值有限.
- 输入管的最初原因和患者咳的有效性与输出管的结果更强烈相关.
- 可能需要进一步的研究来探索其他非侵入性方法来预测EF.
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