Weg J G, Anzueto A, Balk R A, Wiedemann H P, Pattishall E N, Schork M A, Wagner L A
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109, USA.
N Engl J Med. 1998 Feb 5;338(6):341-6. doi: 10.1056/NEJM199802053380601.
In patients with the acute respiratory distress syndrome, pneumothorax and other air leaks - any extrusion of air outside the tracheobronchial tree - have been attributed to high ventilatory pressures or volumes and linked to increased mortality.
We analyzed data from a prospective trial of aerosolized synthetic surfactant in 725 patients with the acute respiratory distress syndrome induced by sepsis. We compared the ventilatory pressures and volumes in the patients without any air leaks (the highest values during the five-day study) with the pressures and volumes in those with pneumothorax or with any air leaks (the highest values during the 16- and 24-hour periods before the complication developed).
Fifty patients (6.9 percent) had pneumothorax and 77 (10.6 percent) had pneumothorax or other air leaks. There were no significant differences between patients with air leaks and those without air leaks in any pressure or volume examined. Overall mortality at 30 days was 40.0 percent (95 percent confidence interval, 36.4 to 43.6); among the patients with pneumothorax, it was 46.0 percent (95 percent confidence interval, 32.2 to 59.8), and among those without pneumothorax, it was 39.3 percent (95 percent confidence interval, 35.6 to 43.0; P=0.35). The mortality rate was 45.5 percent (95 percent confidence interval, 34.4 to 56.6) in the group with any air leaks and 39.0 percent (95 percent confidence interval, 35.3 to 42.8) in the group without air leaks (P=0.28).
In patients with sepsis-induced acute respiratory distress syndrome who were receiving mechanical ventilation with conventional pressures and volumes, there were no significant correlations between high ventilatory pressures or volumes and the development of pneumothorax or other air leaks. Pneumothorax or other air leaks were not associated with a significantly increased mortality rate.
在急性呼吸窘迫综合征患者中，气胸及其他气体泄漏——气管支气管树外的任何气体挤出——被认为是由高通气压力或容量所致，并与死亡率增加相关。
我们分析了一项针对725例脓毒症诱发的急性呼吸窘迫综合征患者进行雾化合成表面活性剂前瞻性试验的数据。我们将无任何气体泄漏患者（五天研究期间的最高值）的通气压力和容量与发生气胸或有任何气体泄漏患者（并发症出现前16至24小时期间的最高值）的压力和容量进行了比较。
50例患者（6.9%）发生气胸，77例患者（10.6%）发生气胸或其他气体泄漏。在检查的任何压力或容量方面，有气体泄漏患者与无气体泄漏患者之间均无显著差异。30天的总体死亡率为40.0%（95%置信区间为36.4%至43.6%）；气胸患者中的死亡率为46.0%（95%置信区间为32.2%至59.8%），无气胸患者中的死亡率为39.3%（95%置信区间为35.6%至43.0%；P = 0.35）。有任何气体泄漏组的死亡率为45.5%（95%置信区间为34.4%至56.6%），无气体泄漏组的死亡率为39.0%（95%置信区间为35.3%至42.8%）（P = 0.28）。
在接受常规压力和容量机械通气的脓毒症诱发的急性呼吸窘迫综合征患者中，高通气压力或容量与气胸或其他气体泄漏的发生之间无显著相关性。气胸或其他气体泄漏与死亡率显著增加无关。
