根据两种检测方法分析撤机早期患者-呼吸机不同步的患病率及其对预后的影响

Prevalence and Prognosis Impact of Patient-Ventilator Asynchrony in Early Phase of Weaning according to Two Detection Methods.

作者信息

Rolland-Debord Camille, Bureau Côme, Poitou Tymothee, Belin Lisa, Clavel Marc, Perbet Sébastien, Terzi Nicolas, Kouatchet Achille, Similowski Thomas, Demoule Alexandre

机构信息

From the Intensive Care Unit and Respiratory Division (Département "R3S"), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, 75013, Paris, France (C.R-D., C.B., T.P., T.S., A.D.) and Biostatistics, Public Health and Medical Information Department (L.B.), Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France; INSERM and UPMC, University Paris 6-Pierre et Marie Curie, UMR_S 1158, "Neurophysiologie Respiratoire Expérimentale et Clinique", Paris, France (C.R.-D., C.B., T.P., T.S., A.D.), Sorbonne Universités, University Paris 6-Pierre et Marie Curie, Paris, France (L.B.); Intensive Care Unit, CHU Limoges, 87042 Limoges Cedex, France (M.C.); Intensive Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France (S.P.); R2D2 EA-7281, Université d'Auvergne, Clermont-Ferrand, France (S.P.); CHU de Caen, Department of Intensive Care, Caen, France (N.T.); Medical ICU, Angers University Hospital, Angers, France (A.K.).

出版信息

Anesthesiology. 2017 Dec;127(6):989-997. doi: 10.1097/ALN.0000000000001886.

DOI:10.1097/ALN.0000000000001886

PMID:28914623

Abstract

BACKGROUND

Patient-ventilator asynchrony is associated with a poorer outcome. The prevalence and severity of asynchrony during the early phase of weaning has never been specifically described. The authors' first aim was to evaluate the prognosis impact and the factors associated with asynchrony. Their second aim was to compare the prevalence of asynchrony according to two methods of detection: a visual inspection of signals and a computerized method integrating electromyographic activity of the diaphragm.

METHODS

This was an ancillary study of a multicenter, randomized controlled trial comparing neurally adjusted ventilatory assist to pressure support ventilation. Asynchrony was quantified at 12, 24, 36, and 48 h after switching from controlled ventilation to a partial mode of ventilatory assistance according to the two methods. An asynchrony index greater than or equal to 10% defined severe asynchrony.

RESULTS

A total of 103 patients ventilated for a median duration of 5 days (interquartile range, 3 to 9 days) were included. Whatever the method used for quantification, severe patient-ventilator asynchrony was not associated with an alteration of the outcome. No factor was associated with severe asynchrony. The prevalence of asynchrony was significantly lower when the quantification was based on flow and pressure than when it was based on the electromyographic activity of the diaphragm at 0.3 min (interquartile range, 0.2 to 0.8 min) and 4.7 min (interquartile range, 3.2 to 7.7 min; P < 0.0001), respectively.

CONCLUSIONS

During the early phase of weaning in patients receiving a partial ventilatory mode, severe patient-ventilator asynchrony was not associated with adverse clinical outcome, although the prevalence of patient-ventilator asynchrony varies according to the definitions and methods used for detection.

摘要

背景

患者与呼吸机不同步与较差的预后相关。撤机早期不同步的发生率和严重程度从未有过具体描述。作者的首要目标是评估不同步对预后的影响及与之相关的因素。第二个目标是根据两种检测方法比较不同步的发生率：信号的目视检查和整合膈肌肌电活动的计算机化方法。

方法

这是一项多中心随机对照试验的辅助研究，比较神经调节通气辅助与压力支持通气。根据两种方法，在从控制通气转换为部分通气辅助模式后的12、24、36和48小时对不同步进行量化。不同步指数大于或等于10%定义为严重不同步。

结果

共纳入103例通气中位时间为5天（四分位间距，3至9天）的患者。无论采用何种量化方法，严重的患者与呼吸机不同步均与预后改变无关。没有因素与严重不同步相关。当基于流量和压力进行量化时，不同步的发生率显著低于基于膈肌肌电活动进行量化时，分别在0.3分钟（四分位间距，0.2至0.8分钟）和4.7分钟（四分位间距，3.2至7.7分钟；P<0.0001）时。