From the R Adams Cowley Shock Trauma Center (P.L.A., T.S., N.M.H.); and Department of Orthopaedics (R.V.O.), University of Maryland School of Medicine, Baltimore Maryland; University of Florida College of Medicine (J.R.S.), Jacksonville; and Orlando Health MERTC (E.J.-K.), Orlando, Florida; Upstate Medical University (S.R., B.S., G.F.N.), Syracuse; and SUNY Cortland (L.A.G.), Cortland, New York.
J Trauma Acute Care Surg. 2013 Oct;75(4):635-41. doi: 10.1097/TA.0b013e31829d3504.
Adult respiratory distress syndrome is often refractory to treatment and develops after entering the health care system. This suggests an opportunity to prevent this syndrome before it develops. The objective of this study was to demonstrate that early application of airway pressure release ventilation in high-risk trauma patients reduces hospital mortality as compared with similarly injured patients on conventional ventilation.
Systematic review of observational data in patients who received conventional ventilation in other trauma centers were compared with patients treated with early airway pressure release ventilation in our trauma center. Relevant studies were identified in a PubMed and MEDLINE search from 1995 to 2012 and included prospective and retrospective observational and cohort studies enrolling 100 or more adult trauma patients with reported adult respiratory distress syndrome incidence and mortality data.
Early airway pressure release ventilation as compared with the other trauma centers represented lower mean adult respiratory distress syndrome incidence (14.0% vs. 1.3%) and in-hospital mortality (14.1% vs. 3.9%).
These data suggest that early airway pressure release ventilation may prevent progression of acute lung injury in high-risk trauma patients, reducing trauma-related adult respiratory distress syndrome mortality.
Systematic review, level IV.
成人呼吸窘迫综合征通常对治疗有抗性，并在进入医疗保健系统后发展。这表明有机会在其发展之前预防这种综合征。本研究的目的是证明在高危创伤患者中早期应用气道压力释放通气与在常规通气的类似损伤患者相比，可降低医院死亡率。
对在其他创伤中心接受常规通气的患者的观察性数据进行系统评价，并与我们创伤中心接受早期气道压力释放通气治疗的患者进行比较。在 1995 年至 2012 年的 PubMed 和 MEDLINE 搜索中，确定了相关研究，包括前瞻性和回顾性观察性和队列研究，纳入了 100 例或更多报告成人呼吸窘迫综合征发生率和死亡率数据的成年创伤患者。
与其他创伤中心相比，早期气道压力释放通气的成人呼吸窘迫综合征发生率（14.0%对 1.3%）和院内死亡率（14.1%对 3.9%）较低。
这些数据表明，早期气道压力释放通气可能预防高危创伤患者急性肺损伤的进展，降低与创伤相关的成人呼吸窘迫综合征死亡率。
系统评价，IV 级。
