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严重急性脑损伤患者的肺保护性机械通风:多中心随机临床试验 (PROLABI)
Luciana Mascia1, Vito Fanelli2,3, Alice Mistretta4
1Department of Experimental Medicine (DIMES), Campus Ecotekne, University of Salento, Lecce, Italy.
American journal of respiratory and critical care medicine
|September 17, 2024
概括
在急性脑损伤患者中,肺保护性通风没有改善结果,并且与传统方法相比,死亡率增加. 由于试验提前结束,需要进行进一步的研究.
科学领域:
- 临界护理医学 临界护理医学
- 神经学 神经学
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 肺保护性通风 (低潮量,PEEP) 是重症监护的标准.
- 它在急性脑损伤 (ABI) 中的使用受到CO2和脑血动力学方面的担忧的限制.
- 之前的试验没有对ABI患者的肺保护策略进行评估.
研究的目的:
- 调查肺保护性通风是否能改善ABI患者的临床结果.
- 假设:较低的潮体积 (VT) 和较高的正极呼气压 (PEEP) 提高了结果.
主要方法:
- 在190名成年ABI患者的多中心,开放标签,受控试验中.
- 肺部保护策略与常规通风策略之间的比较.
- 主要结局:死亡,呼吸机依赖和28天后ARDS的组合.
- 通过牛津残疾量表和格拉斯哥结果量表评估的神经结果.
主要成果:
- 肺部保护策略显示出更高的复合结果 (61.5%对45.3%,RR1.35,P=0.025).
- 观察到死亡率增加 (28.9%与15.1%,RR 1.91,P=0.02) 和对呼吸器的依赖 (42.3%与27.9%,RR 1.52,P=0.039).
- 在ARDS发病率上没有显著差异 (30.8%与22.1%,P=0.179).
- 由于资金终止,审判提前停止.
结论:
- 在没有ARDS的ABI患者中,肺保护性通风并没有降低死亡率,呼吸器依赖或ARDS.
- 在肺部保护策略中没有观察到神经学的益处.
- 由于早期终止,初步发现需要在较大的试验中得到确认.
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