在患有和没有急性脑损伤的患者中,机械通风的方法:基于注册表的队列研究
Yu Tong L Lu1, Shaurya Taran2,3,4, Eddy Fan2,3,4,5
1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Critical care medicine
|November 7, 2025
概括
与非ABI患者相比,急性脑损伤 (ABI) 患者的机械呼吸显示出较低的阳性末尾呼吸压力 (PEEP). 虽然潮体积 (Vt) 和血液气体仍然可比,但在ABI患者中PEEP的应用可能需要优化.
科学领域:
- 关键护理医学 关键护理医学
- 神经学 神经学
- 呼吸系统医学 呼吸系统医学
背景情况:
- 机械通风的策略在患有和没有急性脑损伤 (ABI) 的患者之间有所不同.
- 了解这些差异以及随着时间的推移而演变的实践对于优化患者护理至关重要.
研究的目的:
- 在10年的时间里,在患有和没有ABI的患者中比较机械通风方法.
- 调查实践变化对氧气 (PaO2) 和二氧化碳 (PaCO2) 水平的影响.
主要方法:
- 在成年患者 (≥18岁) 接受侵袭性通风治疗超过48小时 (2014-2023) 的基于注册表的回顾性队列研究.
- 患者被分为有ABI或非ABI的疾病.
- 使用调整的线性混合效应回归比较潮体积 (Vt),正极呼气压 (PEEP),PaCO2和PaO2.
主要成果:
- 包括13,925名患者;25.2%的人有ABI.
- 两组之间的Vt是可比的 (预测体重的中位数为~6mL/kg).
- 在ABI患者中,PEEP显著降低 (5vs8cmH2O;P<0.001),包括低血压呼吸衰竭患者. 虽然随着时间的推移下降趋势,PEEP保持不变.
结论:
- ABI和非ABI患者获得了相似的Vt,随着时间的推移,Vt下降.
- PaCO2和PaO2仍然在指导范围之内.
- 在ABI患者中显著降低PEEP,表明在这个子组中有可能改善PEEP应用.
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