Volle Kim, Merdji Hamid, Bataille Vincent, Lamblin Nicolas, Roubille François, Levy Bruno, Champion Sebastien, Lim Pascal, Schneider Francis, Labbe Vincent, Khachab Hadi, Bourenne Jeremy, Seronde Marie-France, Schurtz Guillaume, Harbaoui Brahim, Vanzetto Gerald, Quentin Charlotte, Combaret Nicolas, Marchandot Benjamin, Lattuca Benoit, Biendel Caroline, Leurent Guillaume, Bonello Laurent, Gerbaud Edouard, Puymirat Etienne, Bonnefoy Eric, Aissaoui Nadia, Delmas Clément
Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, 31059, Toulouse, France.
Faculté de Médecine, Medical Intensive Care Unit, Université de Strasbourg (UNISTRA), Strasbourg University Hospital, Nouvel Hôpital Civil, Strasbourg, France.
Clin Res Cardiol. 2024 Oct 23. doi: 10.1007/s00392-024-02551-x.
Despite scarce data, invasive mechanical ventilation (MV) is widely suggested as first-line ventilatory support in cardiogenic shock (CS) patients. We assessed the real-life use of different ventilation strategies in CS and their influence on short and mid-term prognosis.
FRENSHOCK was a prospective registry including 772 CS patients from 49 centers in France. Patients were categorized into three groups according to the ventilatory supports during hospitalization: no mechanical ventilation group (NV), non-invasive ventilation alone group (NIV), and invasive mechanical ventilation group (MV). We compared clinical characteristics, management, and occurrence of death and major adverse event (MAE) (death, heart transplantation or ventricular assist device) at 30 days and 1 year between the three groups.
Seven hundred sixty-eight patients were included in this analysis. Mean age was 66 years and 71% were men. Among them, 359 did not receive any ventilatory support (46.7%), 118 only NIV (15.4%), and 291 MV (37.9%). MV patients presented more severe CS with more skin mottling, higher lactate levels, and higher use of vasoactive drugs and mechanical circulatory support. MV was associated with higher mortality and MAE at 30 days (HR 1.41 [1.05-1.90] and 1.52 [1.16-1.99] vs NV). No difference in mortality (HR 0.79 [0.49-1.26]) or MAE (HR 0.83 [0.54-1.27]) was found between NIV patients and NV patients. Similar results were found at 1-year follow-up.
Our study suggests that using NIV is safe in selected patients with less profound CS and no other MV indication. NCT02703038.
尽管数据稀缺，但有创机械通气（MV）仍被广泛建议作为心源性休克（CS）患者的一线通气支持手段。我们评估了不同通气策略在CS中的实际应用情况及其对短期和中期预后的影响。
FRESHOCK是一项前瞻性登记研究，纳入了法国49个中心的772例CS患者。根据住院期间的通气支持情况，患者被分为三组：无机械通气组（NV）、单纯无创通气组（NIV）和有创机械通气组（MV）。我们比较了三组患者在30天和1年时的临床特征、治疗情况以及死亡和主要不良事件（MAE，死亡、心脏移植或心室辅助装置）的发生情况。
本分析纳入了768例患者。平均年龄为66岁，男性占71%。其中，359例未接受任何通气支持（46.7%），118例仅接受NIV（15.4%），291例接受MV（37.9%）。MV组患者的CS病情更严重，皮肤花斑更明显，乳酸水平更高，血管活性药物和机械循环支持的使用频率更高。MV组在30天时的死亡率和MAE发生率更高（与NV组相比，HR分别为1.41 [1.05 - 1.90]和1.52 [1.16 - 1.99]）。NIV组和NV组之间在死亡率（HR 0.79 [0.49 - 1.26]）或MAE发生率（HR 0.83 [0.54 - 1.27]）方面未发现差异。1年随访时也得到了类似结果。
我们的研究表明，在CS程度较轻且无其他MV指征 的特定患者中使用NIV是安全的。NCT02703038。
