METHODS: Retrospective cohort study.
METHODS: Twenty-eight-bedded medical-surgical ICU in a private hospital (Argentina).
METHODS: Subjects with arterial pressure of oxygen (AHRF to Fio2 [Pao2/Fio2] < 300 mm Hg) of different etiologies under controlled mechanical ventilation (MV).
METHODS: None.
RESULTS: We collected data during controlled ventilation within 24 hours before SAT followed by the first PSV transition. Failure was defined as the need to return to fully controlled MV within 3 calendar days of PSV start. A total of 274 patients with AHRF (189 COVID-19 and 85 non-COVID-19) were included. The failure occurred in 120 of 274 subjects (43.7%) and was higher in COVID-19 versus non-COVID-19 (49.7% and 30.5%; p = 0.003). COVID-19 diagnosis (odds ratio [OR]: 2.22; 95% CI [1.15-4.43]; p = 0.020), previous neuromuscular blockers (OR: 2.16; 95% CI [1.15-4.11]; p = 0.017) and higher fentanyl dose (OR: 1.29; 95% CI [1.05-1.60]; p = 0.018) increased the failure chances. Higher BMI (OR: 0.95; 95% CI [0.91-0.99]; p = 0.029), Pao2/Fio2 (OR: 0.87; 95% CI [0.78-0.97]; p = 0.017), and pH (OR: 0.61; 95% CI [0.38-0.96]; p = 0.035) were protective. Failure groups had higher 60-day ventilator dependence (p < 0.001), MV duration (p < 0.0001), and ICU stay (p = 0.001). Patients who failed had higher mortality in COVID-19 group (p < 0.001) but not in the non-COVID-19 (p = 0.083).
CONCLUSIONS: In patients with AHRF of different etiologies, the failure of the first PSV attempt was 43.7%, and at a higher rate in COVID-19. Independent risk factors included COVID-19 diagnosis, fentanyl dose, previous neuromuscular blockers, acidosis and hypoxemia preceding SAT, whereas higher BMI was protective. Failure was associated with worse outcomes.
方法:回顾性队列研究。
方法:一家私立医院(阿根廷)的28层医疗外科ICU。
方法:在受控机械通气(MV)下,不同病因的动脉氧压(AHRF至Fio2[Pao2/Fio2]<300mmHg)的受试者。
方法:无。
结果:我们在SAT之前24小时内的受控通气期间收集了数据,然后是第一次PSV过渡。故障定义为需要在PSV开始后的3个日历日内恢复到完全控制的MV。共纳入274例AHRF患者(189例COVID-19和85例非COVID-19)。274名受试者中有120名(43.7%)失败,COVID-19高于非COVID-19(49.7%和30.5%;p=0.003)。COVID-19诊断(比值比[OR]:2.22;95%CI[1.15-4.43];p=0.020),既往使用神经肌肉阻滞剂(OR:2.16;95%CI[1.15-4.11];p=0.017)和更高的芬太尼剂量(OR:1.29;95%CI[1.05-1.60];p=0.018)增加了失败的机会.BMI较高(OR:0.95;95%CI[0.91-0.99];p=0.029),Pao2/Fio2(OR:0.87;95%CI[0.78-0.97];p=0.017),和pH(OR:0.61;95%CI[0.38-0.96];p=0.035)是保护性的。失败组的60天呼吸机依赖性更高(p<0.001),MV持续时间(p<0.0001),和ICU住院(p=0.001)。失败的患者在COVID-19组中死亡率较高(p<0.001),但在非COVID-19组中死亡率较高(p=0.083)。
结论:在不同病因的AHRF患者中,第一次PSV尝试的失败是43.7%,在COVID-19中的比率更高。独立危险因素包括COVID-19诊断,芬太尼剂量,以前的神经肌肉阻滞剂,SAT之前的酸中毒和低氧血症,而较高的BMI是保护性的。失败与更糟糕的结果有关。