Tulaimat Aiman, Trick William E
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America.
Collaborative Research Unit, Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America.
PLoS One. 2017 Jul 3;12(7):e0179641. doi: 10.1371/journal.pone.0179641. eCollection 2017.
The assessment of the work of breathing in the definitions of respiratory failure is vague and variable.
Identify a parsimonious set of signs to describe the work of breathing in hypoxemic, acutely ill patients.
We examined consecutive medical ICU patients receiving oxygen with a mask, non-invasive ventilation, or T-piece. A physician inspected each patient for 10 seconds, rated the level of respiratory distress, and then examined the patient for vital signs and 17 other physical signs. We used the rating of distress as a surrogate for measuring the work of breathing, constructed three multivariate models to identify the one with the smallest number of signs and largest explained variance, and validated it with bootstrap analysis.
We performed 402 observations on 240 patients. Respiratory distress was absent in 78, mild in 157, moderate in 107, and severe in 60. Respiratory rate, hypoxia, heart rate, and frequency of most signs increased as distress increased. Respiratory rate and hypoxia explained 43% of the variance in respiratory distress. Diaphoresis, gasping, and contraction of the sternomastoid explained an additional 28%. Heart rate, blood pressure, alertness, agitation, body posture, nasal flaring, audible breathing, cyanosis, tracheal tug, retractions, paradox, scalene or abdominal muscles contraction did not increase the explained variance in respiratory distress.
Most of the variance is respiratory distress can be explained by five signs summarized by the mnemonic DiapHRaGM (diaphoresis, hypoxia, respiratory rate, gasping, accessory muscle). This set of signs may allow for efficient, standardized assessments of the work of breathing of hypoxic patients.
呼吸衰竭定义中对呼吸做功的评估模糊且多变。
确定一组简洁的体征，用于描述低氧血症急性病患者的呼吸做功情况。
我们检查了连续入住医学重症监护病房且接受面罩吸氧、无创通气或T形管吸氧的患者。一名医生对每位患者检查10秒，评定呼吸窘迫程度，然后检查患者的生命体征及其他17项体征。我们将窘迫评分用作呼吸做功测量的替代指标，构建了三个多变量模型，以确定体征数量最少且解释方差最大的模型，并通过自抽样分析对其进行验证。
我们对240名患者进行了402次观察。78名患者无呼吸窘迫，157名患者为轻度，107名患者为中度，60名患者为重度。随着窘迫程度增加，呼吸频率、低氧血症、心率及大多数体征的出现频率均升高。呼吸频率和低氧血症解释了呼吸窘迫方差的43%。出汗、喘息和胸锁乳突肌收缩又解释了另外28%。心率、血压、意识、躁动、身体姿势、鼻翼扇动、呼吸音、发绀、气管牵拉、凹陷、矛盾呼吸、斜角肌或腹肌收缩并未增加呼吸窘迫的解释方差。
呼吸窘迫的大部分方差可用由DiapHRaGM（出汗、低氧血症、呼吸频率、喘息、辅助肌）这一助记符总结的五个体征来解释。这组体征可能有助于对低氧患者的呼吸做功进行高效、标准化评估。
