PDF(Pubmed)
Abstract：
OBJECTIVE: To describe the rate of failure of the first transition to pressure support ventilation (PSV) after systematic spontaneous awakening trials (SATs) in patients with acute hypoxemic respiratory failure (AHRF) and to assess whether the failure is higher in COVID-19 compared with AHRF of other etiologies. To determine predictors and potential association of failure with outcomes.
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.
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.
摘要：
目的：描述急性低氧性呼吸衰竭（AHRF）患者在系统自发觉醒试验（SAT）后首次过渡到压力支持通气（PSV）的失败率，并评估与其他病因的AHRF相比，COVID-19的失败率是否更高。确定预测因素以及失败与结果的潜在关联。
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。
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。
