男性在急诊科比女性更频繁地接受低潮气量肺保护性通气的治疗。

Males Receive Low-Tidal Volume Component of Lung Protective Ventilation More Frequently than Females in the Emergency Department.

机构信息

Lewis Katz School of Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania.

出版信息

West J Emerg Med. 2020 Apr 16;21(3):684-687. doi: 10.5811/westjem.2020.2.45191.

DOI:10.5811/westjem.2020.2.45191

PMID:32421520

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7234723/

Abstract

INTRODUCTION

Mechanical ventilation is a commonly performed procedure in the emergency department (ED). Approximately 240,000 patients per year receive mechanical ventilation in the ED representing 0.23% of ED visits. An ED-based trial published in 2017 showed that a bundle of interventions in mechanically ventilated patients, including low tidal volume ventilation, reduced the development of acute respiratory distress syndrome by nearly 50%. Prior literature has shown that as many as 40% of ED patients do not receive lung protective ventilation. Our goal was to determine whether differences exist between the percent of males vs females who are ventilated at ≥ 8 milliliters per kilogram (mL/kg) of predicted body weight.

METHODS

We conducted this study at Temple University Hospital, a tertiary care center located in Philadelphia, Pennsylvania. This was a planned subgroup analysis of study looking at interventions to improve adherence to recommended tidal volume settings. We used a convenience sample of mechanically ventilated patients in our ED between September 1, 2017, and September 30, 2018. All adult patient > 18 years old were eligible for inclusion in the study. Our primary outcome measure was the number of patients who had initial tidal volumes set at > 8 mL/kg of predicted body weight. Our secondary outcome was the number of patients who had tidal volumes set at ≥ 8 mL/kg at 60 minutes after initiation of mechanical ventilation.

RESULTS

A total of 130 patients were included in the final analysis. We found that significantly more females were initially ventilated with tidal volumes ≥ 8 mL/kg compared to men: 56% of females vs 9% of males (p=<0.001). Data was available for 107 patients (82%) who were in the ED at 60 minutes after initiation of mechanical ventilation. Again, a significantly larger percentage of females were ventilated with tidal volumes ≥ 8 mL/kg at 60 minutes: 56% of females vs 10% of males (p<0.001).

CONCLUSION

The vast majority of tidal volumes ≥ 8 mL/kg during mechanical ventilation occurs in females. We suggest that objective measurements, such as a tape measure and tidal volume card, be used when setting tidal volumes for all patients, especially females.

摘要

简介

机械通气是急诊科（ED）中常见的操作。每年约有 24 万名患者在 ED 接受机械通气，占 ED 就诊人数的 0.23%。2017 年发表的一项基于 ED 的试验表明，对机械通气患者实施包括低潮气量通气在内的一系列干预措施，可使急性呼吸窘迫综合征的发生率降低近 50%。先前的文献表明，多达 40%的 ED 患者未接受肺保护性通气。我们的目标是确定接受≥8 毫升/公斤（mL/kg）预测体重的男性与女性患者的比例是否存在差异。

方法

我们在宾夕法尼亚州费城的 Temple 大学医院进行了这项研究。这是一项旨在改善推荐潮气量设定依从性的干预措施的研究的计划亚组分析。我们在 2017 年 9 月 1 日至 2018 年 9 月 30 日期间，使用 ED 中机械通气患者的便利样本进行了研究。所有年龄大于 18 岁的成年患者均符合纳入研究的条件。我们的主要观察指标是初始潮气量设定为>8 mL/kg 预测体重的患者人数。我们的次要观察指标是机械通气开始后 60 分钟时潮气量设定为≥8 mL/kg 的患者人数。

结果

共有 130 名患者纳入最终分析。我们发现，初始潮气量设定为≥8 mL/kg 的女性明显多于男性：56%的女性与 9%的男性（p<0.001）。有 107 名（82%）患者在机械通气开始后 60 分钟时的数据可用。同样，有更大比例的女性在 60 分钟时接受了≥8 mL/kg 的潮气量通气：56%的女性与 10%的男性（p<0.001）。