创伤中的急性呼吸困扰综合征2007-2019:综合性患者和中心水平的回顾性队列分析
Zhi Geng1,2, Allyson M Hynes1,3, Alexis M Moren4
1Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
在创伤患者中,急性呼吸窘迫综合征 (ARDS) 减少,但死亡率显著上升. ARDS独立预测30天死亡率,强调需要在高风险创伤病例中改进管理策略.
科学领域:
- 创伤重症监护中心的重症监护中心.
- 肺部医学 肺部医学
- 危急疾病的流行病学.
背景情况:
- 急性呼吸窘迫综合征 (ARDS) 是创伤患者的严重并发症,但其流行病学和对死亡率的影响尚未完全理解.
- 了解创伤中ARDS的趋势和风险因素对于改善患者的治疗结果至关重要.
研究的目的:
- 确定创伤患者中ARDS频率的趋势.
- 确定与ARDS发展和死亡率相关的患者和中心级因素.
- 确定ARDS是否可以独立预测创伤患者的30天死亡率.
主要方法:
- 使用美国外科医生学院国家创伤数据库 (2007-2019) 的数据进行了回顾性队列研究.
- 包括18岁以上的受伤患者,在机械呼吸 (MV) 系统上 ≥2天.
- 多变量后勤回归调整为人口统计,中心特征和血液制品.
主要成果:
- ARDS发病率从每100名MV患者中的22人降至3人 (2007-2019).
- ARDS的危险因素包括的伤害,严重的败血症,呼吸器相关的肺炎和急性损伤 (AKI).
- 原始ARDS死亡率从15.1%增加到29.7% (2007-2019);ARDS独立预测了30天死亡率 (OR 1.32).
结论:
- 尽管ARDS发病率下降,但ARDS创伤患者的死亡率显著增加.
- 在创伤中,ARDS仍然是30天死亡率的强有力的独立预测因素.
- 需要对可修改的患者和中心级因素进行进一步的研究,以减少高风险创伤患者的死亡率.
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