辅助通气期间的失同步预测因素及其对临床结局的影响：EPISYNC 队列研究。

Predictors of asynchronies during assisted ventilation and its impact on clinical outcomes: The EPISYNC cohort study.

机构信息

Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de Sao Paulo, SP, Brazil; Serviço de Fisioterapia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de Sao Paulo, SP, Brazil.

Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.

出版信息

J Crit Care. 2020 Jun;57:30-35. doi: 10.1016/j.jcrc.2020.01.023. Epub 2020 Jan 21.

DOI:10.1016/j.jcrc.2020.01.023

PMID:32032901

Abstract

PURPOSE

To investigate if respiratory mechanics and other baseline characteristics are predictors of patient-ventilator asynchrony and to evaluate the relationship between asynchrony during assisted ventilation and clinical outcomes.

METHODS

We performed a prospective cohort study in patients under mechanical ventilation (MV). Baseline measurements included severity of illness and respiratory mechanics. The primary outcome was the Asynchrony Index (AI), defined as the number of asynchronous events divided by the number of ventilator cycles and wasted efforts. We recorded ventilator waveforms throughout the entire period of MV.

RESULTS

We analyzed 11,881 h of MV from 103 subjects. Median AI during the entire period of MV was 5.1% (IQR:2.6-8.7). Intrinsic PEEP was associated with AI (OR:1.72, 95%CI:1.1-2.68), but static compliance and airway resistance were not. Simplified Acute Physiology Score 3 (OR:1.03, 95%CI:1-1.06) was also associated with AI. Median AI was higher during assisted (5.4%, IQR:2.9-9.1) than controlled (2%, IQR:0.6-4.9) ventilation, and 22% of subjects had high incidence of asynchrony (AI≥10%). Subjects with AI≥10% had more extubation failure (33%) than patients with AI<10% (6%), p = .01.

CONCLUSIONS

Predictors of high incidence of asynchrony were severity of illness and intrinsic PEEP. High incidence of asynchrony was associated with extubation failure, but not mortality.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02687802.

摘要

目的

研究呼吸力学和其他基线特征是否可预测患者-呼吸机的不同步，并评估辅助通气期间的不同步与临床结局之间的关系。

方法

我们对机械通气（MV）患者进行了前瞻性队列研究。基线测量包括疾病严重程度和呼吸力学。主要结局为异步指数（AI），定义为异步事件数与通气周期数和无效努力数的比值。我们在整个 MV 期间记录了呼吸机波形。

结果

我们分析了 103 例患者的 11881 小时 MV。整个 MV 期间的中位数 AI 为 5.1%（IQR：2.6-8.7）。内源性 PEEP 与 AI 相关（OR：1.72，95%CI：1.1-2.68），但静态顺应性和气道阻力则不然。简化急性生理学评分 3（OR：1.03，95%CI：1-1.06）也与 AI 相关。辅助通气（5.4%，IQR：2.9-9.1）时的中位数 AI 高于控制通气（2%，IQR：0.6-4.9），22%的患者存在高发生率的不同步（AI≥10%）。AI≥10%的患者比 AI<10%的患者拔管失败的发生率更高（33% vs. 6%，p=0.01）。