呼吸支和死亡风险在整个心脏病发作冲击严重程度的频谱
Talal El Zarif1, Cesar Caraballo1, Angela M Victoria-Castro2
1Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
概括
包括非侵入性通风 (NIV) 和侵入性机械通风 (IMV) 在内的呼吸支持与心脏性休克 (CS) 患者的住院死亡率增加有关. 这一发现适用于所有SCAI SHOCK阶段,强调其作为风险修饰因素的重要性.
科学领域:
- 心脏病学 心脏病学
- 临界护理医学 临界护理医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 心血管血管血管学与干预学会 (SCAI) 的SHOCK阶段分类心脏性休克 (CS) 风险.
- 2022年更新将呼吸辅助 (非侵入性通风[NIV]或侵入性机械通风[IMV]) 作为分类标准排除在外.
- 呼吸辅助对CS阶段死亡率的影响尚不清楚.
研究的目的:
- 调查CS患者的呼吸支和住院死亡率之间的关联.
- 通过SCAI SHOCK阶段 (B到E) 来分层这个协会.
主要方法:
- 国家数据库 (2015-2023) 的分析,包括成年CS患者 (≥18岁).
- 在入院当天评估呼吸系统的支持 (NIV,IMV或两者).
- 应用逆概率治疗权重来调整混因素并分析住院死亡率.
主要成果:
- 确定了317,325名CS患者;38.0%的人接受了呼吸辅助.
- 呼吸辅助的使用与住院死亡率上升18.3% (95%CI,17.9%-18.7%).
- 在敏感性分析中,这种关联在所有SCAI SHOCK阶段 (B-E) 持续存在.
结论:
- 呼吸系统支持与CS患者的住院死亡率较高有关.
- 呼吸辅助的需要可以作为一个简单的,可识别的风险修饰因子CS.
- 这些发现强调了呼吸支在CS管理和风险分层中的临床意义.
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