Advanced Medical Emergency Department and Critical Care Centre, Maebashi Red Cross Hospital, Gunma, Japan.
Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
PLoS One. 2023 Jan 12;18(1):e0267339. doi: 10.1371/journal.pone.0267339. eCollection 2023.
The benefits of introducing a systematic lung-protective protocol for coronavirus disease 2019 (COVID-19) pneumonia requiring invasive ventilation in the intensive care unit (ICU) are unknown. Herein, we aimed to evaluate the clinical effects of introducing such a protocol in terms of mortality, duration of ventilation, and length of ICU stay. In this single-centre, retrospective, quality comparison study, we identified patients with COVID-19 pneumonia who received invasive ventilation in our ICU between February 2020 and October 2021. We established a systematic lung-protective protocol for the pre-introduction group until March 2021 and the post-introduction group after April 2021. Patients who did not receive invasive ventilation and who underwent veno-venous extracorporeal membrane oxygenation in a referring hospital were excluded. We collected patient characteristics at the time of ICU admission, including age, sex, body mass index (BMI), comorbidities, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, and Murray score. The study outcomes were ICU mortality, length of ICU stay, and duration of ventilation. The pre-introduction and post-introduction groups included 18 and 50 patients, respectively. No significant differences were observed in sex, BMI, SOFA score, APACHE II score, and Murray score; however, age was lower in the post-introduction group (70 vs. 56, P = 0.003). The introduction of this protocol did not improve ICU mortality. However, it reduced the ICU length of stay (26 days vs. 11 days, P = 0.003) and tended to shorten the duration of ventilation (15 days vs. 10 days, P = 0.06). The introduction of the protocol was associated with a decrease in the length of ICU stay and duration of ventilation; however, it did not change mortality. The application of the protocol could improve the security of medical resources during the COVID-19 pandemic. Further prospective multicentre studies are needed.
引入系统的肺保护方案治疗 COVID-19 肺炎患者在 ICU 中接受有创通气的益处尚不清楚。在此，我们旨在评估引入该方案对死亡率、通气时间和 ICU 住院时间的临床影响。在这项单中心回顾性质量比较研究中，我们确定了 2020 年 2 月至 2021 年 10 月期间在我们 ICU 接受有创通气的 COVID-19 肺炎患者。我们为预引入组建立了一个系统的肺保护方案，直到 2021 年 3 月，为后引入组建立了一个方案，在 2021 年 4 月之后。排除未接受有创通气且在转诊医院接受静脉-静脉体外膜氧合的患者。我们收集了 ICU 入院时患者的特征，包括年龄、性别、体重指数（BMI）、合并症、序贯器官衰竭评估（SOFA）评分、急性生理学和慢性健康评估 II（APACHE II）评分和 Murray 评分。研究结果为 ICU 死亡率、ICU 住院时间和通气时间。预引入组和后引入组分别纳入 18 例和 50 例患者。两组间性别、BMI、SOFA 评分、APACHE II 评分和 Murray 评分无显著差异；然而，后引入组年龄较低（70 岁比 56 岁，P = 0.003）。引入该方案并未改善 ICU 死亡率。然而，它缩短了 ICU 住院时间（26 天比 11 天，P = 0.003），并趋于缩短通气时间（15 天比 10 天，P = 0.06）。引入该方案与 ICU 住院时间和通气时间的缩短有关；然而，它并未改变死亡率。该方案的应用可以改善 COVID-19 大流行期间医疗资源的安全性。需要进一步开展前瞻性多中心研究。
