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【medical-news】机械通气>48h ARDS病人的危险因子

Background: Low tidal volume (VT) ventilation for ARDS is a well-accepted concept. However, controversy persists regarding the optimal ventilator settings for patients without ARDS receiving mechanical ventilation. This study tested the hypothesis that ventilator settings influence the development of new ARDS.
Methods: Retrospective analysis of patients from the Multi Parameter Intelligent Monitoring of Intensive Care-II project database who received mechanical ventilation for ≥ 48 h between 2001 and 2005.
Results: A total of 2,583 patients required > 48 h of ventilation. Of 789 patients who did not have ARDS at hospital admission, ARDS developed in 152 patients (19%). Univariate analysis revealed high peak inspiratory pressure (odds ratio [OR], 1.53 per SD; 95% confidence interval [CI], 1.28 to 1.84), increasing positive end-expiratory pressure (OR, 1.35 per SD; 95% CI, 1.15 to 1.58), and VT (OR, 1.36 per SD; 95% CI, 1.12 to 1.64) to be significant risk factors. Major nonventilator risk factors for ARDS included sepsis, low pH, elevated lactate, low albumin, transfusion of packed RBCs, transfusion of plasma, high net fluid balance, and low respiratory compliance. Multivariable logistic regression showed that peak pressure (OR, 1.31 per SD; 95% CI, 1.08 to 1.59), high net fluid balance (OR, 1.3 per SD; 95% CI, 1.09 to 1.56), transfusion of plasma (OR, 1.26 per SD; 95% CI, 1.07 to 1.49), sepsis (OR, 1.57; 95% CI, 1.00 to 2.45), and VT (OR, 1.29 per SD; 95% CI, 1.02 to 1.52) were significantly associated with the development of ARDS.
Conclusions: The associations between the development of ARDS and clinical interventions, including high airway pressures, high VT, positive fluid balance, and transfusion of blood products, suggests that ARDS may be a preventable complication in some cases.
Risk Factors for ARDS in Patients Receiving Mechanical Ventilation for > 48 h
CHEST. 2008;133(4):853-861
背景: 对ARDS施行低潮气量(VT)通气是普遍接受的观念，然而, 关于非ARDS病人接受机械通气的最佳设置仍存争议。本研究验证通气设置影响ARDS发生的假设.
方法: 回顾分析2001-2005年间接受机械通气≥48 h 病人的加强监护-II计划数据库多参数智能监测资料.
结果: 通气时间> 48 h共有2,583个病人，其中789个入院时无ARDS的病人有152例发生ARDS (19%)。单变量分析显示高位吸气压峰值(odds ratio [OR], 1.53/SD; 95%可信区间[CI], 1.28-1.84)、高呼气末正压 (OR, 1.35/SD; 95% CI, 1.15-1.58)和高VT (OR, 1.36 /SD; 95% CI, 1.12-1.64)是ARDS发生的重要危险因子；与通气无关的主要危险因子包括脓毒症、低pH、乳酸盐升高、低蛋白、输注袋装RBC、输血浆、液体净平衡高及呼吸顺应性低。多变量逻辑回归显示峰压(OR, 1.31/SD; 95% CI, 1.08-1.59)、液体净平衡高(OR, 1.3/SD; 95% CI, 1.09-1.56)、输血浆(OR, 1.26/SD; 95% CI, 1.07-1.49)、脓毒症(OR, 1.57; 95% CI, 1.00-2.45)、VT (OR, 1.29/SD; 95% CI, 1.02-1.52)与ARDS发生显著相关。
结论: ARDS发生与临床干预包括高气道压、高 VT、液体正平衡及输注血制品的相关关系提示在某些病例ARDS是可预防的并发症. [标签:content1][标签:content2]

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作者:admin@医学,生命科学    2011-05-24 17:17
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