新型冠状病毒肺炎患者呼吸窘迫时间与有创机械通气之间的关联：一项多中心区域队列研究
Association between respiratory distress time and invasive mechanical ventilation in COVID-19 patients: A multicentre regional cohort study.
作者信息
Busani S, Coloretti I, Baciarello M, Bellini V, Sarti M, Biagioni E, Tonelli R, Marchioni A, Clini E, Guaraldi G, Mussini C, Meschiari M, Tonetti T, Pisani L, Nava S, Bignami E, Ranieri M V, Girardis M
机构信息
Anesthesia and Intensive Care Unit, University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy.
Anesthesia and Intensive Care Unit, University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy.
出版信息
Pulmonology. 2024 May-Jun;30(3):282-286. doi: 10.1016/j.pulmoe.2022.03.004. Epub 2022 Mar 28.
AIM
To determine whether the duration of respiratory distress symptoms in severe COVID-19 pneumonia affects the need for invasive mechanical ventilation and clinical outcomes.
MATERIALS AND METHODS
An observational multicentre cohort study of patients hospitalised in five COVID-19-designated ICUs of the University Hospitals of Emilia-Romagna Region. Patients included were adults with pneumonia due to SARS-CoV-2 with PaO₂/FiO₂ ratio <300 mmHg, respiratory distress symptoms, and need for mechanical ventilation (invasive or non-invasive). Exclusion criteria were an uncertain time of respiratory distress, end-of-life decision, and mechanical respiratory support before hospital admission.
MEASUREMENTS AND MAIN RESULTS
We analysed 171 patients stratified into tertiles according to respiratory distress duration (distress time, DT) before application of mechanical ventilation support. The rate of patients requiring invasive mechanical ventilation was significantly different (p < 0.001) among the tertiles: 17/57 patients in the shortest duration, 29/57 in the intermediate duration, and 40/57 in the longest duration. The respiratory distress time significantly increased the risk of invasive ventilation in the univariate analysis (OR 5.5 [CI 2.48-12.35], p = 0.003). Multivariable regression analysis confirmed this association (OR 10.7 [CI 2.89-39.41], p < 0.001). Clinical outcomes (mortality and hospital stay) did not show significant differences between DT tertiles.
DISCUSSION
Albeit preliminary and retrospective, our data raised the hypothesis that the duration of respiratory distress symptoms may play a role in COVID-19 patients' need for invasive mechanical ventilation. Furthermore, our observations suggested that specific strategies may be directed towards identifying and managing early symptoms of respiratory distress, regardless of the levels of hypoxemia and the severity of the dyspnoea itself.
目的
确定重症新型冠状病毒肺炎（COVID-19）患者呼吸窘迫症状的持续时间是否会影响有创机械通气的需求及临床结局。
材料与方法
对艾米利亚-罗马涅地区大学医院的5个COVID-19指定重症监护病房（ICU）收治的患者进行一项观察性多中心队列研究。纳入的患者为因严重急性呼吸综合征冠状病毒2（SARS-CoV-2）导致肺炎、动脉血氧分压/吸入氧分数值（PaO₂/FiO₂）<300 mmHg、有呼吸窘迫症状且需要机械通气（有创或无创）的成年人。排除标准为呼吸窘迫时间不确定、临终决策以及入院前接受机械呼吸支持。
测量指标与主要结果
我们分析了171例患者，根据机械通气支持应用前的呼吸窘迫持续时间（窘迫时间，DT）分为三分位数。三分位数组间需要有创机械通气的患者比例有显著差异（p<0.001）：最短持续时间组17/57例患者，中间持续时间组29/57例患者，最长持续时间组40/57例患者。单因素分析中，呼吸窘迫时间显著增加了有创通气的风险（比值比[OR]5.5[可信区间（CI）2.48 - 12.35]，p = 0.003）。多变量回归分析证实了这种关联（OR 10.7[CI 2.89 - 39.41]，p<0.001）。DT三分位数组间的临床结局（死亡率和住院时间）未显示出显著差异。
讨论
尽管我们的数据是初步的且为回顾性的，但提出了这样一个假设，即呼吸窘迫症状的持续时间可能在COVID-19患者对有创机械通气的需求中起作用。此外，我们的观察结果表明，可能需要制定特定策略来识别和处理呼吸窘迫的早期症状，而不考虑低氧血症水平和呼吸困难本身的严重程度。
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