Critical Care Centre, Corporación Sanitaria Universitaria Parc Tauli, Sabadell University Hospital, Universidad Autónoma de Barcelona, CIBER Enfermedades Respiratorias, Sabadell, Spain.
Eur Respir J. 2013 Jan;41(1):157-64. doi: 10.1183/09031936.00221611. Epub 2012 Apr 20.
Severe sepsis is one of the most common causes of acute lung injury (ALI) and is associated with high mortality. The aim of the study was to see whether a protective strategy based approach with a plateau pressure <30 cmH(2)O was associated with lower mortality in septic patients with ALI in the Surviving Sepsis Campaign international database. A retrospective analysis of an international multicentric database of 15,022 septic patients from 165 intensive care units was used. Septic patients with ALI and mechanical ventilation (n=1,738) had more accompanying organ dysfunction and a higher mortality rate (48.3% versus 33.0%, p<0.001) than septic patients without ALI (n=13,284). In patients with ALI and mechanical ventilation, the use of inspiratory plateau pressures maintained at <30 cmH(2)O was associated with lower mortality by Chi-squared test (46.4% versus 55.1%, p<0.001) and by Kaplan-Meier and log-rank test (p<0.001). In a multivariable random-effects Cox regression, plateau pressure <30 cmH(2)O was significantly associated with lower mortality (hazard ratio 0.84, 95% CI 0.72-0.99; p=0.038). ALI in sepsis was associated with higher mortality, especially when an inspiratory pressure-limited mechanical ventilation approach was not implemented.
严重脓毒症是急性肺损伤（ALI）最常见的原因之一，与高死亡率相关。本研究旨在观察基于保护策略的平台压<30cmH₂O 是否与国际拯救脓毒症运动（SSC）数据库中患有 ALI 的脓毒症患者的死亡率降低相关。本研究采用了回顾性分析来自 165 个重症监护病房的 15022 例脓毒症患者的国际多中心数据库。患有 ALI 和机械通气的脓毒症患者（n=1738）比没有 ALI 的脓毒症患者（n=13284）有更多的合并器官功能障碍和更高的死亡率（48.3%比 33.0%，p<0.001）。在患有 ALI 和机械通气的患者中，通过卡方检验（46.4%比 55.1%，p<0.001）和 Kaplan-Meier 和对数秩检验（p<0.001）发现，使用平台压维持在<30cmH₂O 的患者死亡率较低。在多变量随机效应 Cox 回归中，平台压<30cmH₂O 与死亡率降低显著相关（风险比 0.84，95%可信区间 0.72-0.99；p=0.038）。脓毒症相关性 ALI 与更高的死亡率相关，尤其是在未实施吸气压力限制机械通气策略的情况下。
