右心室 (RV) 功能障碍患者的机械呼吸模式和结果:一个队列研究
Elizabeth Joyce1, Vincent D Marshall2, Aaron Lopacinski1
1University of Michigan, Department of Internal Medicine, United States of America.
在右心室 (RV) 衰竭患者的肺保护性呼吸 (LPV) 改善了生存率,尽管较低的初始正极呼气压 (PEEP) 并没有显著影响结果. 大多数患者接受了LPV,但很少有人符合低PEEP指南.
科学领域:
- 临界护理医学 临界护理医学
- 心脏病学 心脏病学
- 机械通风机械通风机械通风
背景情况:
- 低潮量 (TV) 和平原压力 (Pplat) 的肺保护性通风 (LPV) 改善了死亡率.
- 使用侵入性机械通风 (IMV) 进行右心室 (RV) 失效管理缺乏广泛的数据.
- ACC的指导方针建议LPV和低阳性终端呼气压 (PEEP) 进行RV失败.
研究的目的:
- 描述心脏ICU患者与RV功能障碍的IMV模式.
- 将IMV实践与ACC临床护理工作组建议进行比较.
- 评估LPV对该群体两年生存时间的影响.
主要方法:
- 对心脏ICU患者进行了回顾性,单中心的研究,这些患者患有VR功能障碍 (2017-2022年).
- 包括RV功能障碍的患者,经心声扫描证实,需要吸入氧气分数≥50%.
- 在最初的24小时内收集了PEEP中位数的数据,并在IMV或28天期间进行了随后的测量.
主要成果:
- 77.6%的患者 (2014/2594) 满足了LPV标准 (TV <8ml/kg,Pplat <30cmH2O). 在这些患者中,有77.6%的患者 (2014/2594) 满足了LPV标准 (TV <8ml/kg,Pplat <30cmH2O).
- LPV与降低两年死亡率 (HR 0.2,p < 0.001) 有显著关联.
- 只有42.4% (59/139) 接受了初始PEEP ≤5cmH2O,这表明与生存没有关联.
结论:
- 大多数VR功能障碍患者接受LPV,符合指南,但很少有人开始低PEEP.
- 在两年后,LPV显示出显著的生存益处.
- 低起始PEEP没有显示出与两年生存率的显著正或负相关性.
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