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基于呼吸机类型的急性呼吸窘迫综合征 SARS-CoV-2 感染患者的 1 年生存率:一项多中心研究。

1-year survival rate of SARS-CoV-2 infected patients with acute respiratory distress syndrome based on ventilator types: a multi-center study.

机构信息

Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.

Medical ICU and Pulmonary Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Sci Rep. 2023 Aug 4;13(1):12644. doi: 10.1038/s41598-023-39992-9.

Abstract

The aim of this study was to evaluate the association between types of ventilator and the one-year survival rate of patients with acute respiratory distress syndrome (ARDS) due to SARS‑CoV-2 infection. This multi-center, retrospective observational study was conducted on 1078 adult patients admitted to five university-affiliated hospitals in Iran who underwent mechanical ventilator (MV) due to ARDS. Of the 1078 patients, 781 (72.4%) were managed with ICU ventilators and 297 (27.6%) with transport ventilators. Overall mortality was significantly higher in patients supported with transport ventilator compared to patients supported with ICU ventilator (16.5% vs. 9.3% P = 0.001). Regression analysis revealed that the expected hazard overall increased with age (HR: 1.525, 95% CI 1.112-1.938, P = 0.001), opacity score (HR: 1.448, 95% CI 1.122-2.074, P = 0.001) and transport ventilator versus ICU ventilator (HR: 1.511, 95% CI 1.143-2.187, P = 0.029). The Kaplan-Meier curves of survival analysis showed that patients supported with ICU ventilator had a significantly higher 1-year survival rate (P = 0.001). In MV patients with ARDS due to COVID-19, management with non-ICU sophisticated ventilators was associated with a higher mortality rate compared to standard ICU ventilators. However, more studies are needed to determine the exact effect of ventilator types on the outcome of critically ill patients.

摘要

本研究旨在评估 SARS-CoV-2 感染所致急性呼吸窘迫综合征(ARDS)患者使用不同类型呼吸机与一年生存率的关系。这是一项多中心、回顾性观察性研究,纳入了伊朗 5 所大学附属医院的 1078 名成人患者,这些患者因 ARDS 接受了机械通气(MV)。在 1078 名患者中,781 名(72.4%)使用了 ICU 呼吸机,297 名(27.6%)使用了转运呼吸机。与使用 ICU 呼吸机的患者相比,使用转运呼吸机的患者死亡率显著更高(16.5% vs. 9.3%,P=0.001)。回归分析显示,总体预期风险随年龄增加而增加(HR:1.525,95%CI 1.112-1.938,P=0.001)、不透明度评分(HR:1.448,95%CI 1.122-2.074,P=0.001)和转运呼吸机与 ICU 呼吸机(HR:1.511,95%CI 1.143-2.187,P=0.029)。生存分析的 Kaplan-Meier 曲线显示,使用 ICU 呼吸机的患者 1 年生存率显著更高(P=0.001)。在 COVID-19 所致 ARDS 的 MV 患者中,与标准 ICU 呼吸机相比,使用非 ICU 高级呼吸机与更高的死亡率相关。然而,需要更多的研究来确定呼吸机类型对危重症患者结局的确切影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4d78/10403549/0d16a45c860b/41598_2023_39992_Fig1_HTML.jpg

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