Faure Morgane, Decavèle Maxens, Morawiec Elise, Dres Martin, Gatulle Nicolas, Mayaux Julien, Stefanescu François, Caliez Julien, Similowski Thomas, Delemazure Julie, Demoule Alexandre
APHP-6 Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France.
APHP-6 Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France; and Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
Respir Care. 2022 Aug;67(8):967-975. doi: 10.4187/respcare.09602. Epub 2022 May 31.
Patients with ARDS due to COVID-19 may require tracheostomy and transfer to a weaning center. To date, data on the outcome of these patients are scarce. The objectives of this study were to determine the factors associated with time to decannulation and limb-muscle strength recovery.
This was an observational retrospective study of subjects with COVID-19-related ARDS requiring tracheostomy after prolonged ventilation, who were subsequently transferred to a weaning center from April 4, 2020-May 30, 2020.
Forty-three subjects were included. Median age (interquartile range) was 61 (48-66) y; 81% were men, and median body mass index (BMI) was 30 (26-35) kg/m. Tracheostomy was performed after a median of 19 (12-27) d of mechanical ventilation, and the median ICU length of stay prior to transfer to the weaning center was 30 (21-46) d. On admission to the weaning center, the median Medical Research Council (MRC) score was 36 (27-44). Time to decannulation was 9 (7-18) d after admission to the weaning center. The only factor independently associated with early decannulation was the MRC score on admission to the weaning center (odds ratio 1.16 [95% CI 1.06-1.31], = .005). Two factors were independently associated with MRC gain ≥ 10: BMI (odds ratio 0.88 [95% CI 0.76-0.99], = .045) and MRC on admission (odds ratio 0.91 [95% CI 0.82-0.98], = .03. Three months after admission to the weaning center, 40 subjects (93%) were weaned from mechanical ventilation and 36 (84%) had returned home.
MRC score at weaning center admission predicted both early decannulation and limb-muscle strength recovery.
新型冠状病毒肺炎（COVID-19）所致急性呼吸窘迫综合征（ARDS）患者可能需要气管切开并转至撤机中心。迄今为止，关于这些患者预后的数据较少。本研究的目的是确定与拔管时间和肢体肌肉力量恢复相关的因素。
这是一项对因COVID-19相关ARDS在长时间通气后需要气管切开、并于2020年4月4日至2020年5月30日转至撤机中心的患者进行的观察性回顾性研究。
纳入43例患者。中位年龄（四分位间距）为61（48 - 66）岁；81%为男性，中位体重指数（BMI）为30（26 - 35）kg/m²。机械通气中位19（12 - 27）天后行气管切开，转至撤机中心前在重症监护病房（ICU）的中位住院时间为30（21 - 46）天。入住撤机中心时，医学研究委员会（MRC）评分中位数为36（27 - 44）。入住撤机中心后拔管时间为9（7 - 18）天。与早期拔管独立相关的唯一因素是入住撤机中心时的MRC评分（比值比1.16 [95%置信区间1.06 - 1.31]，P = 0.005）。与MRC增加≥10独立相关的两个因素是BMI（比值比0.88 [95%置信区间0.76 - 0.99]，P = 0.045）和入住时的MRC评分（比值比0.91 [95%置信区间0.82 - 0.98]，P = 0.03）。入住撤机中心3个月后，40例（93%）患者撤机，36例（84%）患者已出院回家。
入住撤机中心时的MRC评分可预测早期拔管和肢体肌肉力量恢复。
