野战环境中的急性呼吸窘迫综合征。对法国陆军战伤中急性呼吸窘迫综合征病例的回顾性分析。
Acute respiratory distress syndrome in the forward environment. Retrospective analysis of acute respiratory distress syndrome cases among French Army war casualties.
机构信息
From the Intensive Care Unit, Anesthesiology Department (J.S., P.G., E.M., J.B.), Sainte Anne Military Teaching Hospital, Toulon; Intensive Care Unit, Anesthesiology Department (M.B., P.P.), Percy Military Teaching Hospital, Clamart; Tropical Medicine Institute, French Defense Health Service (L.R.), Marseille; Army Medical Center (C.C.), Ventiseri, France); and French Defense Health Service Central Direction (A.L.), Paris, France.
出版信息
J Trauma Acute Care Surg. 2020 Aug;89(2S Suppl 2):S207-S212. doi: 10.1097/TA.0000000000002633.
BACKGROUND
According to the Joint Theater Trauma Registry, 26% to 33% of war casualties develop acute respiratory distress syndrome (ARDS), with high mortality. Here, we aimed to describe ARDS incidence and severity among patients evacuated from war zones and admitted to French intensive care units (ICUs).
METHODS
We performed an observational retrospective multicentric review of all patients evacuated from war zones and admitted to French ICUs between 2003 and 2018. Our analysis included all medical and trauma patients developing ARDS according to the Berlin definition. We evaluated ARDS incidence, and determined ARDS severity from arterial blood gas analysis. Analyzed parameters included invasive ventilation duration, ARDS treatments, ICU stay length, and 30-day and 90-day mortalities.
RESULTS
Among 141 included patients (84% military; median age, 30 years), 57 (42%) developed ARDS. Acute respiratory distress syndrome was mild in 13 (22%) patients, moderate in 24 (42%) patients, and severe in 20 (36%) patients. Evacuation occurred in less than 26 hours for 32 war casualties, 17 non-war-related trauma patients, and 8 medical patients. Among severe trauma patients, median Injury Severity Score was 34, and Abbreviated Injury Scale thorax was 3. Upon French ICU admission, median partial pressure of oxygen in arterial blood/inspirated fraction of oxygen ratio was 241 [144-296]. Administered ARDS treatments included intubation (98%, n = 56), protective ventilation (87%, n = 49), neuromuscular blockade (76%, n = 43), prone position (16%, n = 9), inhaled nitric oxide (10%, n = 6), almitrine (7%, n = 7), and extracorporeal life support (4%, n = 2). Median duration of invasive ventilation was 13 days, ICU stay was 18 days, 30-day mortality was 14%, and 90-day mortality was 21%.
CONCLUSION
Acute respiratory distress syndrome was frequent and severe among French patients evacuated from war theaters. Improved treatment capacities are needed in the forward environment-for example, a specialized US team can provide extracorporeal life support for highly hypoxemic war casualties.
LEVEL OF EVIDENCE
Prognostic and epidemiological study, level III.
背景
根据联合战区创伤登记处的数据，26%至 33%的战伤患者会发展为急性呼吸窘迫综合征（ARDS），死亡率较高。在这里，我们旨在描述从战区撤离并入住法国重症监护病房（ICU）的患者中 ARDS 的发病率和严重程度。
方法
我们对 2003 年至 2018 年间从战区撤离并入住法国 ICU 的所有患者进行了观察性回顾性多中心研究。我们的分析包括根据柏林定义发生 ARDS 的所有内科和创伤患者。我们评估了 ARDS 的发病率，并通过动脉血气分析确定 ARDS 的严重程度。分析的参数包括有创通气时间、ARDS 治疗、ICU 住院时间以及 30 天和 90 天的死亡率。
结果
在 141 名纳入患者（84%为军人；中位年龄 30 岁）中，有 57 名（42%）发生 ARDS。13 名（22%）患者为轻度 ARDS，24 名（42%）患者为中度 ARDS，20 名（36%）患者为重度 ARDS。32 名战伤患者、17 名非战争相关创伤患者和 8 名内科患者的转运时间不到 26 小时。严重创伤患者的损伤严重程度评分中位数为 34，简明损伤量表-胸部评分为 3。入法国 ICU 时，动脉血氧分压/吸入氧分数中位数为 241[144-296]。给予 ARDS 的治疗包括插管（98%，n=56）、保护性通气（87%，n=49）、神经肌肉阻滞剂（76%，n=43）、俯卧位（16%，n=9）、吸入一氧化氮（10%，n=6）、氨茶碱（7%，n=7）和体外生命支持（4%，n=2）。有创通气时间中位数为 13 天，ICU 住院时间中位数为 18 天，30 天死亡率为 14%，90 天死亡率为 21%。
结论
从战区撤离的法国患者中 ARDS 发病率高且严重。在前进环境中需要提高治疗能力，例如，一个专门的美国团队可以为高度低氧血症的战伤患者提供体外生命支持。
证据水平
预后和流行病学研究，III 级。
Zotero 插件