机械通气下胸部创伤患者的驱动压不能预测 ARDS 结局。
Driving pressure is not predictive of ARDS outcome in chest trauma patients under mechanical ventilation.
机构信息
Department of Anaesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France; OcciTRAUMA Network, Regional Network of Medical Organization and Management for Severe Trauma in Occitanie, France.
Department of Anaesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France; OcciTRAUMA Network, Regional Network of Medical Organization and Management for Severe Trauma in Occitanie, France.
出版信息
Anaesth Crit Care Pain Med. 2022 Aug;41(4):101095. doi: 10.1016/j.accpm.2022.101095. Epub 2022 Apr 27.
BACKGROUND
The relationship between the driving pressure of the respiratory system (ΔPrs) under mechanical ventilation and worse outcome has never been studied specifically in chest trauma patients. The objective of the present study was to assess in cases of chest trauma the relationship between ΔPrs and severity of acute respiratory distress syndrome (ARDS) or death and length of stay.
METHODS
A retrospective analysis of severe trauma patients (ISS > 15) with chest injuries admitted to the Trauma Centre from January 2010 to December 2018 was performed. Patients who received mechanical ventilation were included in our analysis. Mechanical ventilation parameters and ΔPrs were recorded during the stay in the intensive care unit. Association of ΔPrs with mortality and outcomes was specifically studied at the onset of ARDS (ΔPrs) by receiver operator characteristic curve analysis, Kaplan-Meier curves, and multivariate analysis.
RESULTS
Among the 266 chest trauma patients studied, 194 (73%) developed ARDS. ΔPrs was significantly higher in the ARDS group versus in the no ARDS group (11.6 ± 2.4 cm HO vs. 10.9 ± 1.9 cm HO, p = 0.04). Among the patients with ARDS, no difference according to the duration of mechanical ventilation was found between the high ΔPrs group (ΔPrs > 14 cm HO) and the low ΔPrs group (ΔPrs ≤ 14 cm HO), (p = 0.75). ΔPrs was not independently associated with the duration of mechanical ventilation (hazard ratio [HR], 1.006; 95% CI, 0.95-1.07; p = 0.8) or mortality (HR, 1.07; 95% CI, 0.9-1.28; p = 0.45). High mechanical power (≥ 12 J/min) was associated with a lower time for weaning of mechanical ventilation in Kaplan-Meier curves but not in multivariate analysis (HR, 0.98; 95% CI, 0.94-1.02; p = 0.22).
CONCLUSION
A high ΔPrs was not significantly associated with an increase in mechanical ventilation duration or mortality risk in ARDS patients with chest trauma in contrast with medical patients.
背景
机械通气下呼吸系统驱动压（ΔPrs）与较差结局之间的关系从未在胸部创伤患者中专门研究过。本研究的目的是评估胸部创伤患者中 ΔPrs 与急性呼吸窘迫综合征（ARDS）或死亡严重程度和住院时间之间的关系。
方法
对 2010 年 1 月至 2018 年 12 月期间因胸部损伤入住创伤中心的严重创伤患者（ISS＞15）进行回顾性分析。纳入接受机械通气的患者。在重症监护病房期间记录机械通气参数和 ΔPrs。通过接收者操作特征曲线分析、Kaplan-Meier 曲线和多变量分析，专门研究 ARDS 发作时（ΔPrs）ΔPrs 与死亡率和结局的关系。
结果
在研究的 266 例胸部创伤患者中，194 例（73%）发生 ARDS。ARDS 组的 ΔPrs 明显高于非 ARDS 组（11.6±2.4cmHO 与 10.9±1.9cmHO，p=0.04）。在 ARDS 患者中，高 ΔPrs 组（ΔPrs＞14cmHO）与低 ΔPrs 组（ΔPrs≤14cmHO）之间，根据机械通气时间无差异（p=0.75）。ΔPrs 与机械通气时间无关（风险比 [HR]，1.006；95%置信区间，0.95-1.07；p=0.8）或死亡率（HR，1.07；95%置信区间，0.9-1.28；p=0.45）。高机械功率（≥12J/min）与 Kaplan-Meier 曲线中机械通气撤机时间缩短相关，但多变量分析中无相关性（HR，0.98；95%置信区间，0.94-1.02；p=0.22）。
结论
与内科患者相比，胸部创伤 ARDS 患者的高 ΔPrs 与机械通气时间延长或死亡率风险增加无关。
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