机械通风创伤患者肺部保护性通风率的变化在农村一级的创伤中心
Jacob M Markwood1, Daniel J Denson2, India R Burdon Dasbach2
1Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03766, United States of America.
肺部保护性通风 (LPV) 在创伤患者中未得到充分使用. 紧急部门的高潮量预测了ICU和OR中持续使用高潮量,增加了肺损伤风险.
科学领域:
- 紧急医疗 紧急医疗
- 临界护理医学 临界护理医学
- 肺部医学 肺部医学
背景情况:
- 建议使用潮体积 ≤8mL/kg预测体重 (PBW) 的肺保护通风 (LPV),但在急诊室不一致地应用.
- 创伤患者面临更高的二次肺损伤风险,但对LPV的研究在这个人群中是有限的.
研究的目的:
- 评估LPV在急诊室的成年创伤患者中的应用.
- 确定急诊室通风策略与ICU和手术室后期护理之间的关联.
主要方法:
- 从2018年至2020年接受机械通风的成人创伤患者 (≥18岁) 的回顾性队列研究.
- 包括用受控通风模式管理的患者;不包括那些被抽管,在ED死亡或在压力支上死亡的患者.
- 主要结局:在ED中接受LPV的患者比例.
主要成果:
- 在289名创伤患者中,38.4%的患者在ED中没有接受LPV治疗.
- 女性接受高潮量 (>8毫升/公斤PBW) 的频率高于男性 (59.5%对31.2%).
- 暴露于高潮体积的ED显著增加了ICU (aOR 15.3) 和OR (aOR 5.6) 中持续高潮体积通风的可能性.
结论:
- 在向ED提交的成人创伤患者中,LPV并未一致实施.
- ED高潮量通风是OR和ICU持续使用高潮量的强有力的预测因素,可能会加剧肺损伤.
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