在急性低血压呼吸衰竭中对患者-呼吸机异步的纵向表征
Candelaria de Haro1,2,3, Alba Xifra-Porxas2,3, Montserrat Batlle2,4,5
1Dr. de Haro, Dr. Roca, Dr. Blanch, and Ms. Gomà are affiliated with Critical Care Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain.
Respiratory care
|May 29, 2025
概括
像反向触发和双重触发这样的患者呼吸器异步在COVID-19 ARDS中很常见. 幸存者的双重触发与更长的通风和更好的ICU生存有关.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统医学 呼吸系统医学
- 肺部病理学 肺部病理学
背景情况:
- COVID-19 ARDS (急性呼吸困难综合征) 在机械通风方面提出了重大挑战.
- 在机械呼吸的患者中经常观察到患者-呼吸器异步 (PVA),这可能会影响结果.
- 了解COVID-19 ARDS中特定PVA的流行率和影响对于优化患者护理至关重要.
研究的目的:
- 确定COVID-19 ARDS需要机械通风的成年患者中PVA的患病率和特征.
- 研究不同类型的PVA与临床结果之间的关联,包括机械通风的持续时间,ICU停留时间和死亡率.
- 确定影响机械通风过程中PVA发生的因素.
主要方法:
- 在两个中心进行了一项观察性队列研究,分析前性收集的真实世界数据.
- 包括患有COVID-19 ARDS的成人患者,需要机械通风超过48小时.
- 包括双重触发,无效努力 (IE) 和反向触发 (有或没有呼吸堆叠) 在内的PVA被使用专用软件检测到持续的呼吸记录.
主要成果:
- 没有呼吸堆叠的反向触发是最常见的异步,其次是双重触发.
- 神经肌肉阻断剂减少了双重触发和IE,但没有反向触发.
- 随着通风持续时间的延长,双重触发的患病率增加,而反向触发的患病率下降.
- 双重触发及其集群与更长的机械通风持续时间和更好的ICU存活率有关.
- 呼吸堆积的逆触发与长时间的机械呼吸和ICU停留有关.
结论:
- 反向触发是COVID-19 ARDS中最常见的PVA,随着时间的推移而减少,双重触发是下一个最常见的.
- 幸存者表现出更高的双重触发的流行率,特别是在自发通风模式.
- 在COVID-19 ARDS患者中,PVA,特别是双触发,与机械通风持续时间和ICU存活率有显著的关联.
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