Intens Care Med:减少脑损伤患者呼吸机相关死亡率的多方位策略!

2017-03-26 xing.T MedSci原创

由此可见,脑损伤患者依从建议的低潮气量、中度PEEP和早期拔管似乎增加了无呼吸机天数。

近日,危重病医学领域权威杂志Intensive Care Medicine上发表了一篇研究文章,研究人员旨在评估在重症监护病房实施多方位减少呼吸道并发症措施的脑损伤患者结局。

该研究是一项前瞻性全国范围内的前后对比试验。研究人员招募了20个法国重症监护室内需要机械通气>24小时的成年急性脑损伤患者,监测和分析了在2013年7月1日至2013年10月31日(4个月)期间有创通气的脑损伤病人的管理。基础期后(2013年11月1日至2013年12月31日),呼吸机的设置和决定拔管作为加快停止有创通气的目标。在干预期间,小潮气量(≤7ml/kg)、中度呼气末正压(PEEP,6-8cmH2O)和早期拔管方案被建议选用。该研究的主要终点是第90天没有进行有创通气的天数。两个期间以及依从组和不依从组进行了比较。

从20个重症监护室中共纳入744名患者(391例干预前;353例干预)。在两个时期第90天没有进行有创通气天数之间无显著差异[71(0-80) vs. 67(0-80)天,P=0.746]。干预之后患者接受完整建议的依从性从8(2%)例增加到52(15%)例(P<0.001)。在第90天,60例(8%)依从推荐治疗方案的患者没有进行有创通气的天数要比684例(92%)偏离推荐方案的患者要多[分别为77(66-82) vs. 71(0-80)天,P=0.03]。在依从组的死亡率为10%,非依从组为26%(P=0.023)。多元分析[风险比(HR)为1.78,95%可信区间(95%CI)为1.41-2.26;P<0.001]和倾向评分调整分析(HR为2.25,95%CI为1.56-3.26,P<0.001)均显示依从性是减少机械通气时间的独立因素。

由此可见,脑损伤患者依从建议的低潮气量、中度PEEP和早期拔管似乎增加了无呼吸机天数。

原始出处:

Karim Asehnoune, et al. A multi-faceted strategy to reduce ventilation-associated mortality in brain-injured patients. The BI-VILI project: a nationwide quality improvement project.Intensive Care Medicine.2017.http://icmjournal.esicm.org/journals/abstract.html?v=0&j=134&i=0&a=4764_10.1007_s00134-017-4764-6&doi=

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    2017-03-28 Boyinsh
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time=2017-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182877, encodeId=d5171828e7ea, content=有点复杂, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=abdd2021478, createdName=五医生, createdTime=Sun Mar 26 17:34:15 CST 2017, time=2017-03-26, status=1, ipAttribution=)]
    2017-03-27 ylzr123

    脑损伤患者依从建议的低潮气量、中度PEEP和早期拔管似乎增加了无呼吸机天数。

    0

  6. 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    2017-03-26 美丽明天在等我

    机械通气和脑损伤是必然联系吗

    0

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GetPortalCommentsPageByObjectIdResponse(id=182881, encodeId=53911828812c, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/03/22/9492b0bdd3ebdf662ab1cde6e8473dca.jpg, createdBy=0f261679513, createdName=万里江山一孤舟, createdTime=Sun Mar 26 18:20:14 CST 2017, time=2017-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182878, encodeId=3fb81828e894, content=如何了解期间的变化, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLBkyaelI9ia3n9SbuKmBdaY0PqCOzd0nhRUstroXmUmXZ5EBTmibtLEvCCIpyHAqxQXGfZz49ibrwjkg/0, createdBy=39781652829, createdName=雾夜芭蕾, createdTime=Sun Mar 26 17:40:58 CST 2017, time=2017-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182877, encodeId=d5171828e7ea, content=有点复杂, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=abdd2021478, createdName=五医生, createdTime=Sun Mar 26 17:34:15 CST 2017, time=2017-03-26, status=1, ipAttribution=)]
    2017-03-26 thlabcde

    真是想尽了办法!

    0

  8. 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time=2017-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182877, encodeId=d5171828e7ea, content=有点复杂, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=abdd2021478, createdName=五医生, createdTime=Sun Mar 26 17:34:15 CST 2017, time=2017-03-26, status=1, ipAttribution=)]
    2017-03-26 万里江山一孤舟

    学习了

    0

  9. 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time=2017-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182877, encodeId=d5171828e7ea, content=有点复杂, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=abdd2021478, createdName=五医生, createdTime=Sun Mar 26 17:34:15 CST 2017, time=2017-03-26, status=1, ipAttribution=)]
    2017-03-26 雾夜芭蕾

    如何了解期间的变化

    0

  10. 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time=2017-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=182877, encodeId=d5171828e7ea, content=有点复杂, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=abdd2021478, createdName=五医生, createdTime=Sun Mar 26 17:34:15 CST 2017, time=2017-03-26, status=1, ipAttribution=)]
    2017-03-26 五医生

    有点复杂

    0

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