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一项单中心随机对照试验研究方案,旨在探讨肺复张对心脏手术后儿科患者的影响。

Study protocol for a single-centre randomised controlled trial to investigate the effect of lung recruitment in paediatric patients after cardiac surgery.

机构信息

Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.

Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.

出版信息

BMJ Open. 2022 May 17;12(5):e063278. doi: 10.1136/bmjopen-2022-063278.

Abstract

INTRODUCTION

A number of published studies have revealed that lung recruitment can improve oxygenation, shorten the duration of mechanical ventilation (MV) and decrease mortality in adults with acute hypoxaemic respiratory failure, especially patients with acute respiratory distress syndrome. However, few articles have assessed lung recruitment in paediatric patients, especially after cardiac surgery. This clinical trial aimed to determine whether lung recruitment can reduce the duration of MV in paediatric patients with hypoxaemic respiratory failure after cardiac surgery.

METHOD AND ANALYSIS

In this trial, we will randomly assign 234 paediatric patients (aged 28 days to 14 years) within 72 hours after cardiac surgery with an arterial oxygen tension (PaO) to fraction of inspired oxygen (FiO) ratio (PaO/FiO) of <300 to either a lung recruitment group or a conventional group. The primary endpoint will be the duration of MV. The secondary endpoints will be ventilator-free days, PaO/FiO, respiratory system compliance, duration of non-invasive ventilation, reintubation rate, length of intensive care unit stay, length of hospital stay, occurrence of serious adverse events (barotrauma, persistent hypotension and arrhythmia), postoperative pulmonary complications.

ETHICS AND DISSEMINATION

The ethics committee of West China Hospital of Sichuan University granted ethics approval for this study (20 August 2019). The results will be published in peer-reviewed journals and presented at conferences.

TRIAL REGISTRATION NUMBER

ChiCTR1900025990.

摘要

简介

多项已发表的研究表明,肺复张可以改善氧合,缩短机械通气(MV)的持续时间,并降低成人急性低氧性呼吸衰竭,尤其是急性呼吸窘迫综合征患者的死亡率。然而,很少有文章评估儿科患者的肺复张情况,尤其是心脏手术后的患者。本临床试验旨在确定肺复张是否可以减少心脏手术后低氧性呼吸衰竭的儿科患者 MV 的持续时间。

方法和分析

在这项试验中,我们将在心脏手术后 72 小时内随机分配 234 名患儿(年龄 28 天至 14 岁),其动脉氧分压(PaO)与吸入氧分数(FiO)的比值(PaO/FiO)<300 分为肺复张组或常规组。主要终点是 MV 的持续时间。次要终点是无呼吸机天数、PaO/FiO、呼吸系统顺应性、无创通气持续时间、再插管率、重症监护病房住院时间、住院时间、严重不良事件(气压伤、持续低血压和心律失常)的发生、术后肺部并发症。

伦理和传播

四川大学华西医院的伦理委员会批准了这项研究(2019 年 8 月 20 日)。结果将发表在同行评议的期刊上,并在会议上展示。

试验注册号

ChiCTR1900025990。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/36ce/9115041/15eb40313ed7/bmjopen-2022-063278f01.jpg

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