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机械通气参数对 COVID-19 相关 ARDS 患者死亡率的预测价值:一项回顾性队列研究。

Predictive value of invasive mechanical ventilation parameters for mortality in COVID-19 related ARDS: a retrospective cohort study.

机构信息

Servicio de Medicina Física y Rehabilitación, Hospital El Carmen de Maipú, Camino A Rinconada 1201, Santiago, Chile.

Latin Division, Keiser University eCampus, Fort Lauderdale, FL, USA.

出版信息

Sci Rep. 2024 Jun 14;14(1):13725. doi: 10.1038/s41598-024-64725-x.

Abstract

The 2019 coronavirus (COVID-19) can generate acute respiratory distress syndrome (ARDS), requiring advanced management within the Intensive Care Unit (ICU) using invasive mechanical ventilation (IMV However, managing this phenomenon has seen learning and improvements through direct experience. Therefore, this study aims were to describe the assessment of the different IMV variables in patients with post-COVID-19 hospitalized in the ICU and their relation with mortality. Observational and retrospective study. The sample was divided into two, the surviving group (SG) and the non-surviving group (NSG). Clinical data were extracted from the electronic clinical file and the respiratory therapist record sheet. The following information was obtained: Patient medical history: gender, age, co-morbidities, arterial gases, days on IMV, and IMV parameters. Out of a total of 101 patients, the total mortality was 32%. There was a significant decrease in respiratory rate (RR) (29.12 ± 4.24-26.78 ± 3.59, p = 0.006), Driving pressure (DP) (11.33 ± 2.39-9.67 ± 1.84, p = 0.002), Ventilatory rate (VR) (2.26 ± 0.66-1.89 ± 0.45, p = 0.001) and a significant rise in Static compliance (Cest) (35.49 ± 8.64-41.45 ± 9.62, p = 0.003) and relation between Arterial oxygen pressure/Inspirated oxygen fraction (PaO/FiO) (201.5 ± 53.98- 227.8 ± 52.11, p = 0.008) after 72 h of IMV, within the NSG compared to the SG. Apart from these points, multi-morbidity (HR = 3.208, p = 0.010) and DP (HR = 1.228, p = 0.030) and VR variables (HR = 2.267, p = 0.027) had more death probabilities. The results of this study indicate that there was a significant increase in RR, DP, VR, and CO and a significant drop in Cest and PaO/FiO among the NSG compared with the SG. Apart from this, the DP and VR variables, multi-morbidity and being male. have more possibility of death.

摘要

2019 年冠状病毒(COVID-19)可引发急性呼吸窘迫综合征(ARDS),需要在重症监护病房(ICU)内使用有创机械通气(IMV)进行高级管理。然而,通过直接经验,人们对这种现象的管理已经有了学习和改进。因此,本研究旨在描述对 COVID-19 后住院 ICU 患者的不同 IMV 变量的评估及其与死亡率的关系。观察性和回顾性研究。样本分为两组,存活组(SG)和非存活组(NSG)。从电子临床档案和呼吸治疗师记录单中提取临床数据。获得以下信息:患者病史:性别、年龄、合并症、动脉血气、IMV 天数和 IMV 参数。在总共 101 名患者中,总死亡率为 32%。RR(29.12±4.24-26.78±3.59,p=0.006)、驱动压力(DP)(11.33±2.39-9.67±1.84,p=0.002)、通气率(VR)(2.26±0.66-1.89±0.45,p=0.001)明显下降,静态顺应性(Cest)(35.49±8.64-41.45±9.62,p=0.003)明显升高,动脉血氧分压/吸入氧分数(PaO/FiO)(201.5±53.98-227.8±52.11,p=0.008)在 NSG 中与 SG 相比,在 IMV 后 72 小时内有显著差异。除此之外,多器官疾病(HR=3.208,p=0.010)和 DP(HR=1.228,p=0.030)和 VR 变量(HR=2.267,p=0.027)的死亡概率更高。本研究结果表明,与 SG 相比,NSG 组的 RR、DP、VR 和 CO 显著增加,Cest 和 PaO/FiO 显著降低。除此之外,DP 和 VR 变量、多器官疾病和男性都有更高的死亡可能性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6cb9/11178920/632a63846769/41598_2024_64725_Fig1_HTML.jpg

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