Gammon R B, Shin M S, Groves R H, Hardin J M, Hsu C, Buchalter S E
Department of Medicine, Birmingham Veterans Administration Medical Center, Alabama, USA.
Am J Respir Crit Care Med. 1995 Oct;152(4 Pt 1):1235-40. doi: 10.1164/ajrccm.152.4.7551376.
Previous investigations have suggested that elevated airway pressures increase the risk of ventilator-induced pneumothorax. However, risk factor analysis using multivariate techniques has not been done. We investigated the hypothesis that airway pressures would not independently correlate with pneumothorax when underlying disease was considered. All ventilated patients over a 1 yr period in the Hohenburg Critical Care Unit at the University of Alabama were followed until death or discharge from the ICU. Ventilator data were collected daily and the presence of pneumomediastinum and pneumothorax determined by review of chest radiographs. Maximal values of airway pressures, minute ventilation, tidal volume, and respiratory rate, as well as age, sex, and underlying disease, were entered into logistic regression analysis. A total of 168 patients was studied, and 20 experienced pneumothorax. Multivariate analysis of the entire ventilated population revealed that only the presence of ARDS independently correlated with pneumothorax. A similar analysis performed on the ARDS population revealed independent correlation only with male sex. Trends toward elevation in airway pressures were seen that did not reach statistical significance. We conclude that development of pneumothorax is most closely correlated with underlying disease, specifically ARDS, and that the associations previously noted between airway pressures and barotrauma largely relate to the occurrence of high airway pressures in ARDS.
先前的研究表明，气道压力升高会增加呼吸机相关性气胸的风险。然而，尚未使用多变量技术进行危险因素分析。我们研究了这样一个假设：当考虑潜在疾病时，气道压力与气胸不会独立相关。对阿拉巴马大学霍恩堡重症监护病房1年内所有接受机械通气的患者进行随访，直至其死亡或从重症监护病房出院。每天收集呼吸机数据，并通过复查胸部X光片确定是否存在纵隔气肿和气胸。将气道压力、分钟通气量、潮气量和呼吸频率的最大值，以及年龄、性别和潜在疾病纳入逻辑回归分析。共研究了168例患者，其中20例发生了气胸。对所有接受机械通气的患者进行多变量分析发现，只有急性呼吸窘迫综合征（ARDS）的存在与气胸独立相关。对ARDS患者进行的类似分析显示，仅与男性性别独立相关。虽然观察到气道压力有升高趋势，但未达到统计学意义。我们得出结论，气胸的发生与潜在疾病，特别是ARDS密切相关，并且先前指出的气道压力与气压伤之间的关联很大程度上与ARDS中高气道压力的发生有关。
