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头盔与面罩无创通气治疗急性呼吸窘迫综合征患者的临床结局比较。

Comparison of the clinical outcomes of non-invasive ventilation by helmet vs facemask in patients with acute respiratory distress syndrome.

机构信息

Critical Care Medicine Department, Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC), Doha, Qatar.

出版信息

Medicine (Baltimore). 2021 Jan 29;100(4):e24443. doi: 10.1097/MD.0000000000024443.

Abstract

ABSTRACT

The main aim of this study is to compare the use of non-invasive ventilation (NIV) via helmet versus face mask where different interfaces and masks can apply NIV. However, some of the limitations of the NIV face mask were air leak, face mask intolerance, and requirement of high positive end expiratory pressure, which could be resolved with the use of the helmet NIV. NIV facemask will be applied as per the facial contour of the patient. NIV helmet is a transparent hood and size will be measured as per the head size. Both groups will have a standard protocol for titration of NIV.Patients aged more than 18 years old and diagnosed with acute respiratory distress syndrome as per Berlin definition will be enrolled in the study after signing the informed consent. Subjects who met the inclusion criteria will receive 1 of the 2 interventions; blood gases, oxygenation status [Po2/Fio2] will be monitored in both groups. The time of intubation will be the main comparison factor among the 2 groups. The primary and secondary outcomes will be measured by the number of patients requiring endotracheal intubation after application of helmet device, Improvement of oxygenation defined as PaO2/FiO2 ≥ 200 or increase from baseline by 100, duration of mechanical ventilation via an endotracheal tube, intensive care unit length of stay, death from any cause during hospitalization at the time of enrolment, need for proning during the hospital stay, intensive care unit mortality, and the degree to which overt adverse effects of a drug can be tolerated by a patient including feeding tolerance.

TRIAL REGISTRATION NUMBER

NCT04507802.

PROTOCOL VERSION

May 2020.

摘要

摘要

本研究的主要目的是比较使用头盔与面罩进行无创通气(NIV)的效果,因为不同的接口和面罩均可应用 NIV。然而,NIV 面罩存在一些局限性,例如漏气、面罩不耐受和需要高呼气末正压,这些问题可以通过使用头盔式 NIV 来解决。NIV 面罩将根据患者的面部轮廓进行适配。NIV 头盔是一个透明的头罩,其尺寸将根据头围进行测量。两组患者均将采用标准的 NIV 滴定方案。在签署知情同意书后,将纳入年龄大于 18 岁且符合柏林定义的急性呼吸窘迫综合征患者。符合纳入标准的受试者将接受两种干预措施中的 1 种;两组患者均将监测血气、氧合状态[Po2/Fio2]。两组患者的主要比较因素为应用头盔装置后需要气管插管的患者数量。主要和次要结局将通过应用头盔装置后需要气管插管的患者数量、氧合改善定义为 PaO2/FiO2≥200 或与基线相比增加 100、经气管内插管机械通气的持续时间、重症监护病房住院时间、入组时住院期间任何原因导致的死亡、住院期间需要俯卧位通气、重症监护病房死亡率以及患者对药物的过度不良反应的耐受程度来衡量,其中包括喂养耐受程度。

试验注册号

NCT04507802。

方案版本

2020 年 5 月。

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