针对急性低血量呼吸衰竭患者的非侵入性或侵入性呼吸支
Jarrod M Mosier1,2, Vignesh Subbian3,4,5, Sarah Pungitore6
1Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, Arizona, United States of America.
对急性缺血性呼吸衰竭的初始非侵入性呼吸支并没有减少住院死亡,但与活着出院的可能性更高有关. 对特定的非侵入性方法的进一步研究是有必要的.
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
- 呼吸系统疗法 呼吸系统疗法
背景情况:
- 非侵入性呼吸辅助 (NIRS) 经常用于急性低血量呼吸衰竭 (AHRF).
- 现有研究经常将NIRS与常规氧气进行比较,而不是侵入性机械通风 (IMV).
- 这项研究直接比较了AHRF患者的初始NIRS和初始IMV.
研究的目的:
- 为了比较初始非侵入性呼吸辅助与侵入性机械通风在AHRF的结果.
- 分析住院时间死亡和住院时间出院的活人.
- 探索非侵入性正压通风 (NIPPV) 和鼻腔高流量 (NHF) 之间的差异.
主要方法:
- 追溯观察队列研究 (2018年1月 - 2019年12月).
- 成年患者 (≥18岁) 患有AHRF,使用经过验证的算法将其分为NIRS或IMV队列.
- 治疗的逆概率加权考克斯模型用于分析初级 (住院死亡) 和二次 (活出院) 结果.
主要成果:
- 包括3177名患者:60%的NIRS,40%的IMV.
- 最初的NIRS与住院死亡率的降低无关 (HR:0.65),但活着出院的可能性增加 (HR:2.26).
- 鼻腔高流显示出更高的住院死亡风险 (HR: 3.27) 但增加活体出院 (HR: 2.12);NIPPV显示出更低的死亡风险 (HR: 0.52) 和增加活体出院 (HR: 2.29).
结论:
- 在AHRF中,非侵入性呼吸支与减少住院死亡率无关.
- 非侵入性呼吸支与活着出院的可能性增加有关.
- 鼻高流和NIPPV对死亡率有不同的影响,但两者都提高了活体排泄的可能性.
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