Zeng Pingping, Lin Yanping, Chen Yongqiang, Tan Guoliang
Department ICU of the Second Affiliated Hospital of Fujian Medical University, China.
Heliyon. 2023 May 6;9(5):e16073. doi: 10.1016/j.heliyon.2023.e16073. eCollection 2023 May.
A retrospective study was performed to investigate the effects of incentive spirometry (IS)respiratory trainer device on lung recruitment in non-intubated moderate ARDS patients.
Moderate ARDS patients who non-intubated from January 2019 to October 2022 were enrolled to the lung recruitment group and the control group. Compared the PaO/FiO (P/F)ratio, lung ultrasound (LUS) score, APACHE-II score, Maximum inspiratory volume during three days (baseline, Day1, Day2, Day3) and the rate of intubation, mean hospital stay, the 28-day in-hospital mortality and the 90-days in-hospital mortality between the two groups.
The lung recruitment group 118 patients (73 males, 47.6 ± 16.5y) and the control group 103 patients (62 males, 50.2 ± 14.8y) were included. The P/F ratios, APACHE-II scores, LUS scores, and the maximum inspiratory volume (ml) were significantly different between the two groups (P = 0.000, P = 0.014, P = 0.013 and P = 0.001, respectively).The P/F ratios were higher (252.6 ± 55.6 v.s, 166.96.9re, = 0.035, day2), (269.8 ± 75.7 v.s 183.9 ± 68.6, = 0.027, day3), the APACHE-II scores were lower (10.0 ± 2.4 v.s 15.3 1e l p = 0.025, day2), (8.0 ± 1.4 v.s 14.1 ± 2.7, p = 0.000, day3), the LUS scores were higher (16.2res wv.s 21.61.6w, p = 0.043, day2), (11.4 ± 5.9 v.s 20.3 ± 6.9, p = 0.004, day3), the maximum inspiratory volumes were higher (1722.3 ± 432.2 v.s 1310.70.732., = 0.044, day2), (1913.5467.2 v.s 1299.79452.5, = 0.018, day3) in Lung Recruitment group than that in Control group. These data at day1, day2, and day3 were significantly improvement than baseline in Lung Recruitment group. Only 36 patients (30.5%) in Lung Recruitment group needed to intubation, while 48 patients (46.6%) in Control group (p = 0.014). The mean hospital stay in lung recruitment group was lower (12.6 ± 4.6 v.s, 18.4 ± 5.3, P = 0.018). The 28-days and the 90-days in-hospital mortality were no statistical significance between the two groups (P = 0.414 and P = 0.418, respectively).
Using IS to perform lung recruitment in moderate ARDS patients can improve maximum inspiratory volume, PaO/FiO ratio, LUS scores, and APACHE-II score and reduce the rate of intubation and the mean hospital stay, but the 28 days and the 90-days in-hospital mortality were not improved.
进行一项回顾性研究，以调查激励肺活量测定法（IS）呼吸训练器对非插管中度急性呼吸窘迫综合征（ARDS）患者肺复张的影响。
将2019年1月至2022年10月期间未插管的中度ARDS患者纳入肺复张组和对照组。比较两组之间的氧合指数（P/F）、肺部超声（LUS）评分、急性生理与慢性健康状况评分系统II（APACHE-II）评分、三天内的最大吸气量（基线、第1天、第2天、第3天）以及插管率、平均住院时间、28天院内死亡率和90天院内死亡率。
纳入肺复张组118例患者（男性73例，47.6±16.5岁）和对照组103例患者（男性62例，50.2±14.8岁）。两组之间的P/F比值、APACHE-II评分、LUS评分和最大吸气量（毫升）有显著差异（分别为P = 0.000、P = 0.014、P = 0.013和P = 0.001）。肺复张组的P/F比值更高（第2天：252.6±55.6对166.9±6.9，P = 0.035），（第3天：269.8±75.7对183.9±68.6，P = 0.027）；APACHE-II评分更低（第2天：10.0±2.4对15.3±1.4，P = 0.025），（第3天：8.0±1.4对14.1±2.7，P = 0.000）；LUS评分更高（第2天：16.2±1.6对21.6±1.6，P = 0.043），（第3天：11.4±5.9对20.3±6.9，P = 0.004）；最大吸气量更高（第2天：1722.3±432.2对1310.7±32.7，P = 0.044），（第3天：1913.5±467.2对1299.7±452.5，P = 0.018）。肺复张组第1天、第2天和第3天的数据与基线相比有显著改善。肺复张组只有36例患者（30.5%）需要插管，而对照组有48例患者（46.6%）（P = 0.014）。肺复张组的平均住院时间更短（12.6±4.6对18.4±5.3，P = 0.018）。两组之间的28天和90天院内死亡率无统计学意义（分别为P = 0.414和P = 0.418）。
对中度ARDS患者使用IS进行肺复张可提高最大吸气量、P/F比值、LUS评分和APACHE-II评分，并降低插管率和平均住院时间，但未改善28天和90天院内死亡率。
