肥胖对于严重新型冠状病毒肺炎管理的影响。
Implications of Obesity for the Management of Severe Coronavirus Disease 2019 Pneumonia.
机构信息
Department of Critical Care Medicine, Arras Hospital, Arras, France.
Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Exhibition Road, London, United Kingdom.
出版信息
Crit Care Med. 2020 Sep;48(9):e761-e767. doi: 10.1097/CCM.0000000000004455.
OBJECTIVES
To investigate patients' characteristics, management, and outcomes in the critically ill population admitted to the ICU for severe acute respiratory syndrome coronavirus disease 2019 pneumonia causing an acute respiratory distress syndrome.
DESIGN
Retrospective case-control study.
SETTING
A 34-bed ICU of a tertiary hospital.
PATIENTS
The first 44 coronavirus disease 2019 acute respiratory distress syndrome patients were compared with a historical control group of 39 consecutive acute respiratory distress syndrome patients admitted to the ICU just before the coronavirus disease 2019 crisis.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Obesity was the most frequent comorbidity exhibited by coronavirus disease 2019 patients (n = 32, 73% vs n = 11, 28% in controls; p < 0.001). Despite the same severity of illness and level of hypoxemia at admission, coronavirus disease 2019 patients failed more high flow oxygen via nasal cannula challenges (n = 16, 100% vs n = 5, 45% in controls; p = 0.002), were more often intubated (n = 44, 100% vs n = 22, 56% in controls; p < 0.001) and paralyzed (n = 34, 77% vs n = 3, 14% in controls; p < 0.001), required higher level of positive end-expiratory pressure (15 vs 8 cm H2O in controls; p < 0.001), more prone positioning (n = 33, 75% vs n = 6, 27% in controls; p < 0.001), more dialysis (n = 16, 36% vs n = 3, 8% in controls; p = 0.003), more hemodynamic support by vasopressors (n = 36, 82% vs n = 22, 56% in controls; p = 0.001), and had more often a prolonged weaning from mechanical ventilation (n = 28, 64% vs n = 10, 26% in controls; p < 0.01) resulting in a more frequent resort to tracheostomy (n = 18, 40.9% vs n = 2, 9% in controls; p = 0.01). However, an intensive management requiring more staff per patient for positioning coronavirus disease 2019 subjects (6 [5-7] vs 5 [4-5] in controls; p < 0.001) yielded the same ICU survival rate in the two groups (n = 34, 77% vs n = 29, 74% in controls; p = 0.23).
CONCLUSIONS
In its most severe form, coronavirus disease 2019 pneumonia striked preferentially the vulnerable obese population, evolved toward a multiple organ failure, required prolonged mechanical ventilatory support, and resulted in a high workload for the caregivers.
目的
研究因严重急性呼吸综合征冠状病毒病 2019 引起的急性呼吸窘迫综合征而入住 ICU 的危重病患者的特征、治疗方法和结局。
设计
回顾性病例对照研究。
地点
一家 34 张床位的三级医院的 ICU。
患者
将 44 例新型冠状病毒病 2019 急性呼吸窘迫综合征患者与在新型冠状病毒病 2019 危机前入住 ICU 的 39 例连续急性呼吸窘迫综合征患者的历史对照组进行比较。
干预措施
无。
测量和主要结果
肥胖是新型冠状病毒病患者最常见的合并症（n=32，73% vs 对照组 11 例，28%；p<0.001）。尽管入院时的疾病严重程度和低氧血症程度相同，但新型冠状病毒病患者经鼻导管高流量氧挑战失败的比例更高（n=16，100% vs 对照组 5 例，45%；p=0.002），需要插管的比例更高（n=44，100% vs 对照组 22 例，56%；p<0.001）和使用肌松剂的比例更高（n=34，77% vs 对照组 3 例，14%；p<0.001），需要更高水平的呼气末正压（15 比对照组 8cmH2O；p<0.001），需要更多的俯卧位通气（n=33，75% vs 对照组 6 例，27%；p<0.001），需要更多的透析（n=16，36% vs 对照组 3 例，8%；p=0.003），需要更多的血管加压药物来支持血流动力学（n=36，82% vs 对照组 22 例，56%；p=0.001），并且机械通气撤机时间延长的比例更高（n=28，64% vs 对照组 10 例，26%；p<0.01），因此气管切开的比例更高（n=18，40.9% vs 对照组 2 例，9%；p=0.01）。然而，为了对新型冠状病毒病患者进行体位管理，需要每个患者配备更多的医护人员（6[5-7]比对照组 5[4-5]；p<0.001），这两组的 ICU 生存率相同（n=34，77% vs 对照组 29 例，74%；p=0.23）。
结论
在其最严重的形式中，新型冠状病毒病 2019 肺炎主要侵袭脆弱的肥胖人群，发展为多器官衰竭，需要长时间的机械通气支持，并给护理人员带来了高工作量。
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