Tejerina Eva, Pelosi Paolo, Muriel Alfonso, Peñuelas Oscar, Sutherasan Yuda, Frutos-Vivar Fernando, Nin Nicolás, Davies Andrew R, Rios Fernando, Violi Damian A, Raymondos Konstantinos, Hurtado Javier, González Marco, Du Bin, Amin Pravin, Maggiore Salvatore M, Thille Arnaud W, Soares Marco Antonio, Jibaja Manuel, Villagomez Asisclo J, Kuiper Michael A, Koh Younsuck, Moreno Rui P, Zeggwagh Amine Ali, Matamis Dimitrios, Anzueto Antonio, Ferguson Niall D, Esteban Andrés
Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, Genoa, Italy.
J Crit Care. 2017 Apr;38:341-345. doi: 10.1016/j.jcrc.2016.11.010. Epub 2016 Nov 18.
In neurologically critically ill patients with mechanical ventilation (MV), the development of acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality, but the role of ventilatory management has been scarcely evaluated. We evaluate the association of tidal volume, level of PEEP and driving pressure with the development of ARDS in a population of patients with brain injury.
We performed a secondary analysis of a prospective, observational study on mechanical ventilation.
We included 986 patients mechanically ventilated due to an acute brain injury (hemorrhagic stroke, ischemic stroke or brain trauma). Incidence of ARDS in this cohort was 3%. Multivariate analysis suggested that driving pressure could be associated with the development of ARDS (odds ratio for unit increment of driving pressure 1.12; confidence interval for 95%: 1.01 to 1.23) whereas we did not observe association for tidal volume (in ml per kg of predicted body weight) or level of PEEP. ARDS was associated with an increase in mortality, longer duration of mechanical ventilation, and longer ICU length of stay.
In a cohort of brain-injured patients the development of ARDS was not common. Driving pressure was associated with the development of this disease.
在接受机械通气（MV）的神经重症患者中，急性呼吸窘迫综合征（ARDS）的发生是发病和死亡的主要原因，但通气管理的作用几乎未得到评估。我们评估了潮气量、呼气末正压（PEEP）水平和驱动压与脑损伤患者群体中ARDS发生之间的关联。
我们对一项关于机械通气的前瞻性观察性研究进行了二次分析。
我们纳入了986例因急性脑损伤（出血性卒中、缺血性卒中和脑外伤）接受机械通气的患者。该队列中ARDS的发生率为3%。多因素分析表明，驱动压可能与ARDS的发生有关（驱动压每增加一个单位的比值比为1.12；95%置信区间：1.01至1.23），而我们未观察到潮气量（每千克预测体重的毫升数）或PEEP水平与之有关联。ARDS与死亡率增加、机械通气时间延长以及重症监护病房（ICU）住院时间延长有关。
在脑损伤患者队列中，ARDS的发生并不常见。驱动压与该疾病的发生有关。
