儿童肺部和隔膜保护性通风的随机试验
Robinder G Khemani1,2, Anoopindar Bhalla1,2, Justin C Hotz1
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles.
NEJM evidence
|May 27, 2025
概括
一个计算机化决策支持工具 (REDvent) 改善了儿童的肺部和隔膜保护性通风,显著缩短了断奶时间. 建议对机械通风患者进行进一步的III期试验.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 呼吸系统生理学 呼吸系统生理学
- 医疗信息学 医疗信息学
背景情况:
- 机械通风策略平衡肺部和隔膜保护需要进一步的临床验证.
- 关于计算机化决策支持工具在儿科机械通风中的有效性数据有限.
研究的目的:
- 为了评估计算机化决策支持 (CDS) 工具,REDvent,结合食道计量用于ARDS儿童的肺部和隔膜保护性通风.
- 为了比较接受REDvent干预的儿童的断奶时间与通常的护理.
主要方法:
- 一个单中心的II期随机对照试验,涉及248名患有急性呼吸困扰综合征的儿童.
- 随机分配发生在通风的急性和断奶阶段.
- 干预组使用了REDvent CDS工具和食道测量仪;对照组接受了通常的护理. 在两组中每天进行自发呼吸试验 (SBT).
主要成果:
- 在急性阶段,与常规护理相比,REDvent组的峰值吸入压力 (-3 cmH2O) 和阳性末尾呼气压力 (-2 cmH2O) 降低.
- 55%的REDvent患者通过了SBT或在第一次尝试时被抽管,而在通常护理组中只有39%.
- REDvent干预与1.67的断奶时间缩短的几率相关 (P=0.045),SBT通过的中位时间为3.83天与4.75天.
结论:
- 在急性通风阶段使用REDvent CDS工具的肺和隔膜保护性通风策略缩短了儿童的断奶时间.
- 当在断奶阶段随机分配时,临床结果在两组之间是相似的.
- 进一步的III期试验是有必要的,以证实这些发现在机械通风患者.
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