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在重症监护室中取消机械通风:一项前性观察研究
Corey R Fehnel1,2,3, Zara Cooper4,3, Margaret Campbell5
1Hebrew SeniorLife, Marcus Institute for Aging Research, Boston, USA.
CHEST critical care
|December 2, 2025
概括
几乎所有重症监护室 (ICU) 患者在缓和性取消机械通风 (WMV) 期间都会经历痛苦. 在WMV之前预先服用阿片类药物可能会减少患者的痛苦,并改善终身护理.
科学领域:
- 关键护理医学 关键护理医学
- 抚慰性护理是一种缓解性护理.
- 在生命末期的护理.
背景情况:
- 超过五分之一的美国人死于重症监护室 (ICU).
- 大约50%的这些患者接受了缓和性取消机械通风 (WMV).
- 很少有人知道患者的经验和最佳实践,以尽量减少WMV期间的痛苦.
研究的目的:
- 描述患者在WMV后的痛苦.
- 为了确定与WMV后患者痛苦相关的因素.
主要方法:
- 对153名机械通风患者进行前性队列研究 (OBSERVE-WMV),这些患者正在过渡到舒适护理.
- 从2021年1月到2022年7月,在两个学术医疗中心的12个重症监护室收集的数据.
- 在WMV后评估呼吸困难,疼痛或动荡的累积发病率;多变量Poisson回归确定了相关因素.
主要成果:
- 91%的患者在WMV后经历了至少一个痛苦的情节 (90%的呼吸困难,56%的疼痛,5%的动荡).
- 41%的患者有超过三次痛苦情节.
- 在WMV之前预先服用阿片类药物与较低的痛苦风险相关 (aIRR为0.74).
- 较长的ICU停留 (>10天),较低的意识和WMV前的痛苦与更高的痛苦风险有关.
结论:
- 几乎所有接受WMV的ICU患者都会经历痛苦.
- 在WMV之前预先服用阿片类药物可能有助于减轻患者的痛苦.
- 对WMV期间症状管理的最佳实践进行进一步研究是有必要的.
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