创伤后急性呼吸窘迫综合征患者体外膜肺氧合治疗的结局：一项倾向匹配分析
Outcomes of Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome Following Traumatic Injury: A Propensity-Matched Analysis.
作者信息
Ahmed Nasim, Kuo Yen-Hong, Pratt Abimbola
机构信息
Division of Trauma & Surgical Critical Care, Department of Surgery, Jersey Shore University Medical Center, Neptune, NJ.
Office of Research Administration, Jersey Shore University Medical Center, Neptune, NJ.
出版信息
Crit Care Explor. 2021 May 14;3(5):e0421. doi: 10.1097/CCE.0000000000000421. eCollection 2021 May.
OBJECTIVES
The purpose of this study is to evaluate the overall occurrence of inhospital mortality in trauma patients who were placed on extracorporeal membrane oxygenation following the complication of the acute respiratory distress syndrome.
DESIGN
Observational cohort study.
SETTING
The data of all patients who were traumatically injured and developed the complication of acute respiratory distress syndrome were accessed from the Trauma Quality Improvement Program database from the calendar years of 2013 to 2016.
PATIENTS
Patients 16 years old and less than 90 years old were included in the study. Variables included patient demography, Injury Severity Score, Glasgow Coma Scale score, Abbreviated Injury Scale score, and outcomes.
INTERVENTIONS
Extracorporeal membrane oxygenation.
MEASUREMENTS AND MAIN RESULTS
Propensity-matched analysis was performed between two groups: patients placed on extracorporeal membrane oxygenation and patients placed on conventional mode of ventilation. The primary outcome was inhospital mortality. Out of 6,121 patients who developed acute respiratory distress syndrome, 118 patients (1.93%) were placed on extracorporeal membrane oxygenation. The pair matched analysis showed significant difference between the two groups (extracorporeal membrane oxygenation vs conventional mode of ventilation) for overall inhospital mortality (35.6% vs 14.4%; < 0.001). There were significant differences found between the two groups for the median hospital length of stay (41 [35-49] vs 27 [24-33]), ICU days (35 [30-41] vs 19 [17-24]), and ventilator days (30 [27-34] vs 15 [13-18]). All values are less than 0.001.
CONCLUSIONS
Approximately 2% of acute respiratory distress syndrome patients were placed on extracorporeal membrane oxygenation. The overall inhospital mortality remained high despite patients being placed on extracorporeal membrane oxygenation.
目的
本研究旨在评估因急性呼吸窘迫综合征并发症而接受体外膜肺氧合治疗的创伤患者的院内死亡率总体发生率。
设计
观察性队列研究。
背景
从2013年至2016年的创伤质量改进项目数据库中获取所有因创伤受伤并出现急性呼吸窘迫综合征并发症患者的数据。
患者
纳入16岁至90岁以下的患者。变量包括患者人口统计学、损伤严重程度评分、格拉斯哥昏迷量表评分、简明损伤量表评分及结局。
干预措施
体外膜肺氧合。
测量指标及主要结果
对两组患者进行倾向匹配分析：接受体外膜肺氧合治疗的患者和接受传统通气模式的患者。主要结局为院内死亡率。在6121例发生急性呼吸窘迫综合征的患者中，118例（1.93%）接受了体外膜肺氧合治疗。配对匹配分析显示，两组在总体院内死亡率方面存在显著差异（体外膜肺氧合组 vs 传统通气模式组：35.6% vs 14.4%；<0.001）。两组在中位住院时间（41[35 - 49]天 vs 27[24 - 33]天）﹑重症监护病房住院天数（35[30 - 41]天 vs 19[17 - 24]天）和呼吸机使用天数（30[27 - 34]天 vs 15[13 - 18]天）方面均存在显著差异。所有P值均小于0.001。
结论
约2%的急性呼吸窘迫综合征患者接受了体外膜肺氧合治疗。尽管患者接受了体外膜肺氧合治疗，但总体院内死亡率仍然很高。
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