在COVID-19的机械通风患者中,延长的躺姿和90天的死亡率
Alfonso Estrella-Alonso1, J Alberto Silva-Obregón2, Rodrigo Fernández-Tobar3
1Department of Intensive Care Medicine, Hospital Universitario de Guadalajara, Guadalajara, Spain; and Hospital La Paz Health Research Institute (IdiPaz), Madrid, Spain. fonsi_e.alonso@yahoo.es.
延长倾斜定位 (EPP) 显著改善了在机械通风中患有严重ARDS的COVID-19患者的90天生存率. 这种方法在治疗呼吸衰竭方面具有潜在的好处,需要进一步研究.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 传染性疾病 传染性疾病
背景情况:
- 俯卧 (PP) 改善了急性呼吸困难综合征 (ARDS) 患者需要机械通风的结果.
- 延长PP (>24小时) 的有效性在降低特定于COVID-19患者的ARDS死亡率仍然不确定.
研究的目的:
- 评估延长卧床定位 (EPP) 的影响,定义为卧床时间≥32小时,对90天生存率的影响.
- 评估EPP对中度至重度ARDS需要机械通风的COVID-19患者的影响.
主要方法:
- 对158名中度至重度ARDS机械通风COVID-19患者进行了回顾性队列研究.
- 标准PP (SPP) (n=76) 和EPP (n=82) 的比较.
- 使用卡丁度匹配 (CM),匹配权重 (MW) 和稳定/修剪权重 (SW) 的统计调整以最大限度地减少偏差.
主要成果:
- 总体而言,90天死亡率为31.7%.
- 未调整的90天死亡率在EPP中为19.5%,而在SPP中为44.7% (HR 0.35).
- 调整后的分析 (CM,MW,SW) 始终显示,EPP组的90天死亡率较低 (HRs从0.29到0.45不等).
结论:
- 延长倾斜定位 (EPP) 与严重ARDS的机械通风COVID-19患者的90天生存率的改善有关.
- 欧洲人民党展示了与COVID-19相关的呼吸衰竭管理的潜在好处.
- 需要进一步的前性研究来证实这些发现,并探索潜在的机制.
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