Kotani Toru, Katayama Shinshu, Miyazaki Yuya, Fukuda Satoshi, Sato Yoko, Ohsugi Koichi
Department of Anesthesiology and Intensive Care Medicine, Tokyo Women's Medical University, Tokyo 162-8666, Japan.
Biomed Res Int. 2017;2017:7452604. doi: 10.1155/2017/7452604. Epub 2017 May 8.
The risk factors for the mortality rate of pneumonia (PCP) who required mechanical ventilation (MV) remained unknown.
A retrospective chart review was performed of all PCP patients admitted to our intensive care unit and treated for acute hypoxemic respiratory failure to assess the risk factors for the high mortality.
Twenty patients without human immunodeficiency virus infection required mechanical ventilation; 19 received noninvasive ventilation; and 11 were intubated. PEEP was incrementally increased and titrated to maintain FIO as low as possible. No mandatory ventilation was used. Sixteen patients (80%) survived. Pneumothorax developed in one patient with rheumatoid arthritis (RA). Median PEEP level in the first 5 days was 10.0 cmHO and not associated with death. Multivariate analysis showed the association of incidence of interstitial lung disease and increase in serum KL-6 with 90-day mortality.
We found MV strategies to prevent pneumothorax including liberal use of noninvasive ventilation, and PEEP titration and disuse of mandatory ventilation may improve mortality in this setting. Underlying disease of interstitial lung disease was a risk factor and KL-6 may be a useful predictor associated with mortality in patients with RA. These findings will need to be validated in larger studies.
需要机械通气（MV）的肺炎（PCP）患者死亡率的危险因素尚不清楚。
对入住我们重症监护病房并因急性低氧性呼吸衰竭接受治疗的所有PCP患者进行回顾性病历审查，以评估高死亡率的危险因素。
20例无人类免疫缺陷病毒感染的患者需要机械通气；19例接受无创通气；11例进行了气管插管。逐步增加呼气末正压（PEEP）并进行滴定，以保持尽可能低的吸入氧浓度（FIO）。未使用强制通气。16例患者（80%）存活。1例类风湿关节炎（RA）患者发生气胸。前5天的PEEP中位数为10.0cmH₂O，与死亡无关。多因素分析显示间质性肺疾病的发生率和血清KL-6升高与90天死亡率相关。
我们发现预防气胸的MV策略包括广泛使用无创通气，PEEP滴定和不使用强制通气可能会改善这种情况下的死亡率。间质性肺疾病的基础疾病是一个危险因素，KL-6可能是与RA患者死亡率相关的有用预测指标。这些发现需要在更大规模的研究中得到验证。
