在COVID-19呼吸衰竭患者中醒着易受定位:一项随机临床试验
Anatole Harrois1, Romain Jouffroy2,3, Soufia Ayed4
1Service d'Anesthésie Réanimation Chirurgicale, DMU 12 Anesthésie Réanimation Chirurgicale Médecine Péri-Opératoire et Douleur, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Équipe DYNAMIC, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S999, Le Kremlin-Bicêtre, France.
JAMA network open
|December 10, 2025
概括
对于患有缺血性呼吸衰竭的COVID-19患者,清醒易感定位 (APP) 显著降低了输管或死亡的需要. 这项干预支持APP.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 传染性疾病 传染性疾病
背景情况:
- 在COVID-19患者中,严重的肺炎往往会导致缺血性呼吸衰竭.
- 觉醒倾向定位 (APP) 已被探索为一种非侵入性方法,以改善氧化.
- 在COVID-19的非输管患者中,APP的临床有效性仍在调查中.
研究的目的:
- 评估APP对COVID-19相关的低血压呼吸衰竭患者的输管和死亡率的影响.
- 评估标准化APP协议在改善临床结果方面的有效性.
主要方法:
- 一项随机临床试验,涉及445名非输管成年COVID-19患者,需要补充氧气.
- 患者被随机分配1:1接受每天至少6小时的APP或标准护理.
- 主要结局是输管和/或28天内死亡的复合结果.
主要成果:
- 该研究发现,与标准护理相比,APP降低了输管和/或死亡的复合结果的可能性很高 (93.8%). (OR,0.74;95%CRI,0.48-1.09).
- 二次结果,包括在ICU和医院以外的活日,显示了有利于APP的趋势,但没有达到统计学意义.
- 在活着的日子和没有机械通风的日子之间没有观察到任何显著的差异.
结论:
- 每天至少6小时保持清醒的倾向性定位可能对非输管COVID-19患者具有缺血性呼吸衰竭有益.
- APP显示了降低内内管管道输入和/或死亡的高概率.
- 这些发现支持将APP整合到临床实践中,用于管理COVID-19引起的低血量肺炎.
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