计划性排泄后的预防性非侵入性氧气治疗对高风险患者的排泄失败的影响:回顾性倾向得分匹配的队列研究
Xiaozhuo Zheng1,2, Lixiong Lu1,2, Mengyi Ma3
1Department of Anesthesiology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
Frontiers in medicine
|October 11, 2024
概括
预防性非侵入性氧气疗法 (NIT) 在高风险的ICU患者中显著降低了输出失败. 这种疗法,包括高流量鼻腔管 (HFNC),对老年人特别有益,并为非侵入性通风 (NIV) 提供了替代方案.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统疗法 呼吸系统疗法
- 患者的治疗结果.
背景情况:
- 输出失败 (EF) 是重症监护室 (ICU) 的一个重大挑战,导致不良预后,特别是在高风险人群中.
- 预防性非侵入性氧疗法 (NIT) 的有效性,包括非侵入性通风 (NIV) 和高流量鼻 (HFNC),在减轻这些患者的EF仍然是争论的主题.
研究的目的:
- 调查出管后预防性NIT对降低高风险ICU患者出管失败率的影响.
- 为了比较NIT与常规氧化疗法 (COT) 在预防再输管的有效性.
主要方法:
- 从2018年3月到2023年12月,在ICU中进行了一项回顾性观察研究.
- 包括高风险的成年患者,他们接受了24小时以上的机械呼吸,并通过了自发呼吸试验.
- 患者在输出管后立即接受NIT或COT,主要结局是输出管在7天内失败.
主要成果:
- 与常规氧化疗法 (COT) 相比,非侵入性氧化疗法 (NIT) 在倾向匹配的队列中显著降低了输出失败率 (17.6%与32.2%,p < 0.001) 和再输入率 (11.5%与19.8%,p = 0.014).
- 多变量分析确定了预防性NIT和较高的ROX指数作为EF的保护因素,而较高的液体平衡,快速浅呼吸指数 (RSBI) 和妄是危险因素.
- 亚组分析表明,在老年患者中,输出管后NIT的效果更大,HFNC证明不低于NIV,并显示了减少妄想发病率的趋势.
结论:
- 输出管后预防性NIT是一种有效的策略,可以减少高风险ICU患者的输出管失败,特别是老年人.
- 高流量鼻腔管 (HFNC) 为此目的而成为非侵入性通风 (NIV) 的可行替代方案.
- 流体平衡,RSBI,ROX指数和妄想是影响输出失败发生的关键因素.
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