从控制到辅助通风的早期与延迟的切换:一个目标试验仿真
Carmen A T Reep1, Evert-Jan Wils2, Lucas M Fleuren1
1Erasmus Medical Center, Intensive Care Unit, Rotterdam, Zuid-Holland, Netherlands.
American journal of respiratory and critical care medicine
|January 21, 2025
概括
从控制到辅助机械通风的早期切换可以加速为重症患者的呼吸机释放. 这一策略缩短了侵入性机械通风的持续时间和重症监护室 (ICU) 停留时间,而不会增加死亡率.
科学领域:
- 临界护理医学 临界护理医学
- 呼吸系统疗法 呼吸系统疗法
- 临床试验 临床试验
背景情况:
- 切换到辅助通风是摆脱机械通风患者的关键.
- 这种切换的最佳时间在重症患者中仍未研究.
研究的目的:
- 为了比较早期与延迟切换到辅助通风.
- 评估对机械通风持续时间,ICU停留时间和死亡率的影响.
主要方法:
- 使用WEAN SAFE数据集进行目标试验模拟.
- 早期切换 (1天内) 与资格后延迟切换 (1+天) 的比较.
- 主要结局:28天成功的输出;次要:ICU退院,死亡率.
主要成果:
- 早期切换导致在28天内成功输出4天的额外4天输出.
- 与在28日成功出管的累积发病率提高7%有关.
- 增加了28日的ICU出院率 (11%) 和减少了ICU停留时间.
结论:
- 早期从控制通风切换到辅助通风可以缩短机械通风的持续时间.
- 早期切换与集中护理病房停留时间的缩短有关.
- 两种策略之间没有观察到ICU死亡率的显著差异.
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