急性呼吸窘迫综合征患者随机临床试验中头盔与面罩无创通气的一年结局。
One-Year Outcomes in Patients With Acute Respiratory Distress Syndrome Enrolled in a Randomized Clinical Trial of Helmet Versus Facemask Noninvasive Ventilation.
机构信息
Department of Medicine, Section of Pulmonary/Critical Care, University of Chicago, Chicago, IL.
Department of Medicine, Internal Medicine Residency Program, University of Chicago, Chicago, IL.
出版信息
Crit Care Med. 2018 Jul;46(7):1078-1084. doi: 10.1097/CCM.0000000000003124.
OBJECTIVES
Many survivors of acute respiratory distress syndrome have poor long-term outcomes possibly due to supportive care practices during "invasive" mechanical ventilation. Helmet noninvasive ventilation in acute respiratory distress syndrome may reduce intubation rates; however, it is unknown if avoiding intubation with helmet noninvasive ventilation alters the consequences of surviving acute respiratory distress syndrome.
DESIGN
Long-term follow-up data from a previously published randomized controlled trial.
PATIENTS
Adults patients with acute respiratory distress syndrome enrolled in a previously published clinical trial.
SETTING
Adult ICU.
INTERVENTION
None.
MEASUREMENTS AND MAIN RESULTS
The primary outcome was functional independence at 1 year after hospital discharge defined as independence in activities of daily living and ambulation. At 1 year, patients were surveyed to assess for functional independence, survival, and number of institution-free days, defined as days alive spent living at home. The presence of ICU-acquired weakness and functional independence was also assessed by a blinded therapist on hospital discharge. On hospital discharge, there was a greater prevalence of ICU-acquired weakness (79.5% vs 38.6%; p = 0.0002) and less functional independence (15.4% vs 50%; p = 0.001) in the facemask group. One-year follow-up data were collected for 81 of 83 patients (97.6%). One-year mortality was higher in the facemask group (69.2% vs 43.2%; p = 0.017). At 1 year, patients in the helmet group were more likely to be functionally independent (40.9% vs 15.4%; p = 0.015) and had more institution-free days (median, 268.5 [0-354] vs 0 [0-323]; p = 0.017).
CONCLUSIONS
Poor functional recovery after invasive mechanical ventilation for acute respiratory distress syndrome is common. Helmet noninvasive ventilation may be the first intervention that mitigates the long-term complications that plague survivors of acute respiratory distress syndrome managed with noninvasive ventilation.
目的
急性呼吸窘迫综合征（ARDS）幸存者的长期预后较差，可能与“有创”机械通气期间的支持治疗措施有关。ARDS 患者应用头盔式无创通气可降低插管率；但尚不清楚避免使用头盔式无创通气而插管是否会改变 ARDS 幸存者的结局。
设计
先前发表的随机对照试验的长期随访数据。
患者
先前临床试验中纳入的 ARDS 成年患者。
设置
成人 ICU。
干预
无。
测量和主要结果
主要结局为出院后 1 年时的功能独立性，定义为日常生活活动和步行的独立性。在 1 年时，通过问卷调查评估功能独立性、生存情况以及机构无天数，即生存在家中的天数。出院时，由盲法治疗师评估 ICU 获得性肌无力和功能独立性。与面罩组相比，在出院时头盔组 ICU 获得性肌无力的发生率更高（79.5% vs. 38.6%；p = 0.0002），功能独立性更低（15.4% vs. 50%；p = 0.001）。83 例患者中的 81 例（97.6%）完成了 1 年随访。面罩组 1 年死亡率更高（69.2% vs. 43.2%；p = 0.017）。在 1 年时，头盔组患者更可能达到功能独立性（40.9% vs. 15.4%；p = 0.015），机构无天数更多（中位数，268.5[0-354] vs. 0[0-323]；p = 0.017）。
结论
急性呼吸窘迫综合征行有创机械通气后，功能恢复不良较为常见。头盔式无创通气可能是减轻接受无创通气治疗的 ARDS 幸存者长期并发症的首个干预措施。
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