急性呼吸窘迫综合征患者呼吸努力与生存的关联
Association of Breathing Effort With Survival in Patients With Acute Respiratory Distress Syndrome.
作者信息
Parrilla-Gómez Francisco José, Castellví-Font Andrea, Boutonnet Víctor, Parrilla-Gómez Andrés, Antolín Terreros Marta, Mestre Somoza Cristina, Blanes Bravo Marina, Pratsobrerroca de la Rubia Paola, Martín-López Eva, Marco Santiago, Festa Olimpia, Brochard Laurent J, Goligher Ewan C, Masclans Enviz Joan Ramon
机构信息
Critical Care Department, Hospital del Mar, Barcelona, Spain.
Critical Illness Research Group (GREPAC), Hospital del Mar Research Institute (HMRI), Barcelona, Spain.
出版信息
Crit Care Med. 2025 Oct 1;53(10):e1982-e1994. doi: 10.1097/CCM.0000000000006797. Epub 2025 Aug 5.
OBJECTIVES
Invasive mechanical ventilation (IMV) is crucial for acute respiratory distress syndrome (ARDS) management, but mortality remains high. While spontaneous breathing is key to weaning, excessive respiratory effort may injure the lung and diaphragm. Most existing data on respiratory effort during IMV are based on brief periods of observation, potentially underestimating the burden of inappropriate efforts. This study aims to characterize the evolution of respiratory effort over time in ARDS patients and its relation to survival. We hypothesized that nonsurvivors would spend a greater proportion of time in the high-effort range during the active breathing phase compared with survivors.
DESIGN, SETTING, AND PATIENTS: In this prospective cohort study, we continuously recorded airway pressure, flow, esophageal, and gastric pressures in ARDS patients on mechanical ventilation during 7 days after the onset of spontaneous breathing. We analyzed physiologic respiratory effort variables, focusing on the proportion of time spent within defined effort ranges, and compared these data between ICU survivors and nonsurvivors. Statistical analysis was conducted using variance weighted methods to account for variability in the number of respiratory cycles analyzed per patient. This study is registered at ClinicalTrials.gov under identifier NCT06490523.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
A total of 1,485,405 respiratory cycles were analyzed from 26 ARDS patients (19 survivors, seven nonsurvivors). Nonsurvivors spent significantly more time in high effort (12% vs. 3%; p = 0.006). In contrast, survivors spent more time in the moderate-effort range (50% vs. 5%; p < 0.001). The time spend with high dynamic transpulmonary driving pressure (> 25 cm H 2 O) was also significantly different between groups (32% survivors vs. 74% nonsurvivors; p = 0.001).
CONCLUSIONS
Patients who die of ARDS are more likely to be exposed to high respiratory effort for prolonged periods of time compared with survivors.
目的
有创机械通气（IMV）对急性呼吸窘迫综合征（ARDS）的治疗至关重要，但死亡率仍然很高。虽然自主呼吸是撤机的关键，但过度的呼吸用力可能会损伤肺和膈肌。大多数关于IMV期间呼吸用力的现有数据基于短时间观察，可能低估了不适当用力的负担。本研究旨在描述ARDS患者呼吸用力随时间的变化及其与生存的关系。我们假设与幸存者相比，非幸存者在主动呼吸阶段处于高用力范围的时间比例更高。
设计、设置和患者：在这项前瞻性队列研究中，我们连续记录了ARDS患者在自主呼吸开始后7天内接受机械通气时的气道压力、流量、食管和胃内压力。我们分析了生理呼吸用力变量，重点关注在定义的用力范围内所花费的时间比例，并比较了ICU幸存者和非幸存者之间的这些数据。使用方差加权方法进行统计分析，以考虑每位患者分析的呼吸周期数量的变异性。本研究已在ClinicalTrials.gov上注册，标识符为NCT06490523。
干预措施
无。
测量和主要结果
对26例ARDS患者（19例幸存者，7例非幸存者）的1485405个呼吸周期进行了分析。非幸存者在高用力状态下花费的时间显著更多（12%对3%；p = 0.006）。相比之下，幸存者在中等用力范围内花费的时间更多（50%对5%；p < 0.001）。两组之间高动态跨肺驱动压力（> 25 cm H₂O）的时间也有显著差异（幸存者为32%，非幸存者为74%；p = 0.001）。
结论
与幸存者相比，死于ARDS的患者更有可能长时间处于高呼吸用力状态。
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