低血压呼吸衰竭辅助通风期间驾驶压力的增加与ICU生存率的降低有关:ICEBERG研究
Alice Grassi1, Isabella Bianchi2, Maddalena Teggia Droghi3
1University of Toronto Anesthesiology & Pain Medicine, Toronto General Hospital, Toronto, Canada.
概括
辅助通风期间的驱动压力与ICU的结果有关. 较高的驾驶压力和较低的非幸存者的正常化合规性表明它们对患者预后的重要性.
科学领域:
- 临界护理医学 临界护理医学
- 呼吸系统生理学 呼吸系统生理学
- 机械通风机械通风机械通风
背景情况:
- 驾驶压力是严重程度的关键指标,也是控制通风中肺部保护的目标.
- 它在辅助通风过程中的作用在很大程度上是未知的.
- 吸气和呼气保持提供了估计准静态和动态驱动压力的方法.
研究的目的:
- 为了研究驾驶压力在辅助呼吸和重症监护室 (ICU) 的结果之间的关系.
- 评估准静态和肺间动态驾驶压力与患者存活率之间的相关性.
主要方法:
- 一项多中心前性观察性研究,涉及298名急性低血量呼吸衰竭患者.
- 患者在启动呼吸机支持后的48小时内被录取.
- 呼吸机制每天都被测量,关键变量是部分辅助的前三天的平均值. 监测了高达90天的ICU结局.
主要成果:
- 在幸存者和非幸存者之间没有观察到潮体积,气道峰值压力或PEEP的显著差异.
- 准静态的驱动压力和肺间的动态驱动压力在未幸存者中显著更高 (p<0.001).
- 非幸存者的正常化遵守率较低 (p<0.001),多变量分析证实了与结果的关联.
结论:
- 驾驶压力和正常化遵守与辅助呼吸器患者的ICU结果有关,尽管有一些重叠.
- 虽然并未确定因果关系,但在自发呼吸期间监测驱动压力可能具有临床价值.
- 这项研究强调了驾驶压力管理在辅助通风设置中改善患者预后的潜在重要性.
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