7mL/kgPBW或更高的潮体积可能对COVID-19患者来说是安全的
Alessandro Protti1, Fabiana Madotto2, Gaetano Florio2
1Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Journal of critical care
|September 26, 2024
概括
较高的潮体积 (7-9毫升/公斤PBW) 可能会降低COVID-19急性呼吸困扰综合征 (ARDS) 患者的ICU死亡率. 这项研究表明,ARDS管理的通风策略可能会发生转变.
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:
- 在急性呼吸窘迫综合征 (ARDS) 中机械通风的最佳潮体积受到争议,特别是在COVID-19大流行期间.
- 目前的建议各不相同,有些人建议6毫升/千克预测体重 (PBW),而另一些人则建议针对特定患者子组提供更高的体积.
研究的目的:
- 为了研究潮体积≥7mL/kg的PBW在COVID-19患者的安全性和有效性.
- 为了确定更高的潮体积是否与该群体的重症监护室 (ICU) 死亡率降低有关,特别是在不同肺部符合性的患者中.
主要方法:
- 一项涉及600名机械通风COVID-19患者的多中心研究的二次分析.
- 患者被分为两组:通风患者的PBW<7mL/kg和那些PBW≥7mL/kg的患者.
- 肺部符合性被分为<40,40-50,或>50毫升/厘米H2O.
主要成果:
- 346名患者接受PBW<7毫升/千克 (平均6.2±0.5毫升/千克PBW),254名患者接受PBW≥7毫升/千克 (平均7.9±0.9毫升/千克PBW).
- 在低潮量组中,ICU死亡率为33%,在高潮量组中为29% (p=0.272).
- 多变量分析表明,在所有合规类别中,潮体积≥7mL/kgPBW与较低的ICU死亡率 (OR:0.62;95%CI:0.40-0.95) 有关.
结论:
- 潮体积为7-9毫升/千克的PBW与ARDS的COVID-19患者的ICU死亡率降低有关,即使是在那些肺部较低的患者中 (<40毫升/厘米H2O).
- 这些发现表明,更高的潮体积可能是安全和有益的,但由于研究的回顾性质,应该谨慎地解释.
关键词:
急性呼吸应急综合征 (ARDS) 是一种急性呼吸应急综合征.冠状病毒疾病2019年 (COVID-19) 是一个疾病.驱动压力 驱动压力 驱动压力肺部保护性通风器的使用机械通风机械通风机械通风机潮的体积是潮的体积.更多相关视频
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