Shen Yanfei, Cai Guolong, Gong Shijin, Dong Lei, Yan Jing, Cai Wanru
Department of Intensive Care, Zhejiang Hospital, No. 12, Linyin Road, Hangzhou, 310000, Zhejiang, People's Republic of China.
Respiratory Department, The Second Affiliated Hospital of Zhejiang Chinese Medicine University, No. 318, Chaowang Road, Hangzhou, 310005, People's Republic of China.
Crit Care. 2019 Jul 12;23(1):254. doi: 10.1186/s13054-019-2530-6.
Although low tidal volume is strongly recommended for acute respiratory distress syndrome (ARDS), whether or not the benefit varies according to the severity of ARDS remains unclear. This study aimed to investigate whether or not there is an interaction between low tidal volume and severity of ARDS.
This was a secondary analysis from a randomized controlled trial. The patients were subgrouped according to whether the PaO/FiO (P/F) was > 150 or ≤ 150 mmHg on day 0. The interaction between a tidal volume of 6 mL/kg and the P/F was investigated in hierarchical chi-square analysis and logistic regression models.
Eight hundred and thirty-six patients with ARDS were enrolled (345 in the high P/F subgroup [> 150 mmHg] and 491 in the low P/F subgroup [≤ 150 mmHg]). Compared to the traditional tidal volume group, the mortality of patients with low tidal volume was significantly lower in the high P/F subgroup (41/183 (22.4%) vs. 64/162 (39.5%), p = 0.001) but not in the low P/F subgroup (95/256 (37.1%) vs. 96/235 (40.8%), p = 0.414). In the hierarchical chi-square analysis, the test of homogeneity was significant (risk ratio of mortality 0.56 [0.40-0.79] vs. 0.91 [0.73-1.13], p = 0.018). In the multivariable logistic model, the odds ratio of mortality for the interacted item was significant (2.02, 95% confidence interval [CI] 1.06-3.86, p = 0.033). The odds ratio of mortality for low tidal volume was significant in the high P/F subgroup (0.42, 95% CI 0.24-0.72, p = 0.002) but not in the low P/F subgroup (0.89, 95% CI 0.60-1.31, p = 0.554).
The benefits of low tidal volume ventilation remain uncertain in patients with severe ARDS. Further studies are needed to validate this significant interaction.
尽管强烈推荐对急性呼吸窘迫综合征（ARDS）患者采用低潮气量通气，但这种益处是否因ARDS的严重程度而异仍不清楚。本研究旨在调查低潮气量与ARDS严重程度之间是否存在相互作用。
这是一项对随机对照试验的二次分析。根据第0天的动脉血氧分压/吸入氧分数值（PaO₂/FiO₂，P/F）>150或≤150 mmHg将患者分为亚组。在分层卡方分析和逻辑回归模型中研究6 mL/kg潮气量与P/F之间的相互作用。
共纳入836例ARDS患者（高P/F亚组[>150 mmHg]345例，低P/F亚组[≤150 mmHg]491例）。与传统潮气量组相比，低潮气量组患者的死亡率在高P/F亚组中显著降低（41/183（22.4%）对64/162（39.5%），p = 0.001），但在低P/F亚组中未显著降低（95/256（37.1%）对96/235（40.8%），p = 0.414）。在分层卡方分析中，齐性检验具有显著性（死亡率风险比0.56[0.40 - 0.79]对0.91[0.73 - 1.13]，p = 0.018）。在多变量逻辑模型中，相互作用项的死亡率比值比具有显著性（2.02，95%置信区间[CI]1.06 - 3.86，p = 0.033）。低潮气量的死亡率比值比在高P/F亚组中具有显著性（0.42，95% CI 0.24 - 0.72，p = 0.002），但在低P/F亚组中不具有显著性（0.89，95% CI 0.60 - 1.31，p = 0.554）。
低潮气量通气对重度ARDS患者的益处仍不确定。需要进一步研究来验证这种显著的相互作用。
