Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades, 149 rue de Sèvres, University Paris Descartes, 75015 Paris, France; Department of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote, School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, Ontario, Canada.
Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades, 149 rue de Sèvres, University Paris Descartes, 75015 Paris, France.
Am J Emerg Med. 2019 Oct;37(10):1860-1863. doi: 10.1016/j.ajem.2018.12.047. Epub 2019 Jan 7.
Mechanical ventilation can cause deleterious effects on the lung and thus alter patient's prognosis. The aim of this study was to describe the characteristics of prehospital mechanical ventilation in patients with septic shock requiring mechanical ventilation in the prehospital setting.
Patients with septic shock subjected to pre-hospital intubation and mechanical ventilation by a mobile intensive care unit were consecutively included and retrospectively analysed. Septic shock was defined according to the international sepsis-3 consensus conference. Patient's characteristics, interventions, prehospital ventilatory parameters and outcome were retrieved from medical records. The association between the tidal volume indexed on ideal body weight (VTIBW) and mortality at day 28 was evaluated.
Fifty-nine patients were included. Septic shock was mainly associated with pulmonary (64%) infection. Mean pre-hospital VTIBW was 7 ± 1 ml.kg in the overall population. Mortality reached 42%. The AUC of VTIBW was 0.83 [0.72-0.94]. Using logistic regression model including: age, prehospital mean blood pressure, volume infused in the prehospital setting, FiO and length of stay in the intensive care unit, the association with mortality remained significant for VTIBW (OR adjusted [CI95] = 4.11 [1.89-10.98]), VTIBW >8 ml·kg (OR adjusted [CI95] = 8.29 [2.35-34.98]) and VTIBW <8 ml·kg (OR adjusted [CI95] = 0.12 [0.03-0.43]).
In this retrospective study, we observed an association between mortality at day 28 and prehospital VTIBW in pre-hospital mechanically ventilated patients with septic shock. A VTIBW <8 ml·kg was associated with a decrease and a VTIBW >8 ml·kg with an increase in mortality.
机械通气可能对肺部造成有害影响，从而改变患者的预后。本研究的目的是描述在院前环境中需要机械通气的感染性休克患者的院前机械通气特点。
连续纳入并回顾性分析了由移动重症监护单元进行院前插管和机械通气的感染性休克患者。感染性休克的定义符合国际脓毒症-3 共识会议的标准。从病历中提取患者特征、干预措施、院前通气参数和结局。评估理想体重指数潮气量（VTIBW）与 28 天死亡率的相关性。
共纳入 59 例患者。感染性休克主要与肺部（64%）感染有关。总体人群的院前 VTIBW 平均为 7±1ml/kg。死亡率为 42%。VTIBW 的 AUC 为 0.83[0.72-0.94]。使用包括年龄、院前平均血压、院前输液量、FiO2 和 ICU 住院时间的逻辑回归模型，VTIBW 与死亡率的相关性仍有统计学意义（调整后的 OR [95%CI]为 4.11[1.89-10.98]），VTIBW>8ml·kg（调整后的 OR [95%CI]为 8.29[2.35-34.98]）和 VTIBW<8ml·kg（调整后的 OR [95%CI]为 0.12[0.03-0.43]）。
在这项回顾性研究中，我们观察到院前机械通气的感染性休克患者的 28 天死亡率与院前 VTIBW 之间存在相关性。VTIBW<8ml·kg 与死亡率降低相关，VTIBW>8ml·kg 与死亡率升高相关。
