PDF(Pubmed)
Abstract：
UNASSIGNED: Application of individualized positive end-expiratory pressure (PEEP) based on minimum driving pressure facilitates to prevent from postoperative pulmonary complications (PPCs). Whether lung protective ventilation strategy can reduce the risk of PPCs in COVID-19 patients remains unclear. In this study, we compared the effects of driving pressure-guided ventilation with conventional mechanical ventilation on PPCs in patients with COVID-19.
UNASSIGNED: Patients infected COVID-19 within 30-day before surgery were retrospectively enrolled consecutively. Patients were divided into two group: driving pressure-guided lung protective ventilation strategy group (LPVS group) and conventional mechanical ventilation group (Control group). Propensity score matching for variables selected was used by logistic regression with the nearest-neighbor method. The outcomes were the incidence of PPCs and hypoxemia in post-anesthesia care unit.
UNASSIGNED: There was no significant difference in the baseline data between both groups (P > 0.05). The incidence of PPCs (12.73 % vs 36.36 %, χ2 = 7.068, P = 0.008) and hypoxemia [18.18 % vs 38.18 %, χ2 = 4.492, P = 0.034], and lung ultrasound scores [4.68 ± 1.60 vs 8.39 ± 1.87, t = 8.383, P < 0.001] in LPVS group were lower than control group. The PEEP, airway pressure and plateau pressure in LPVS group were higher than control group, but driving pressure and tidal volume was lower than control group, the difference was statistically significant (P < 0.05).
UNASSIGNED: Individualized PEEP ventilation strategy guided by minimum driving pressure could improve oxygenation and reduce the incidence of PPCs in surgical patients with COVID-19.
UNASSIGNED: Patients infected COVID-19 within 30-day before surgery were retrospectively enrolled consecutively. Patients were divided into two group: driving pressure-guided lung protective ventilation strategy group (LPVS group) and conventional mechanical ventilation group (Control group). Propensity score matching for variables selected was used by logistic regression with the nearest-neighbor method. The outcomes were the incidence of PPCs and hypoxemia in post-anesthesia care unit.
UNASSIGNED: There was no significant difference in the baseline data between both groups (P > 0.05). The incidence of PPCs (12.73 % vs 36.36 %, χ2 = 7.068, P = 0.008) and hypoxemia [18.18 % vs 38.18 %, χ2 = 4.492, P = 0.034], and lung ultrasound scores [4.68 ± 1.60 vs 8.39 ± 1.87, t = 8.383, P < 0.001] in LPVS group were lower than control group. The PEEP, airway pressure and plateau pressure in LPVS group were higher than control group, but driving pressure and tidal volume was lower than control group, the difference was statistically significant (P < 0.05).
UNASSIGNED: Individualized PEEP ventilation strategy guided by minimum driving pressure could improve oxygenation and reduce the incidence of PPCs in surgical patients with COVID-19.
摘要：
■基于最小驱动压力的个性化呼气末正压（PEEP）的应用有助于预防术后肺部并发症（PPC）。肺保护性通气策略是否能降低COVID-19患者发生PPC的风险尚不清楚。在这项研究中,我们比较了驱动压力引导通气和常规机械通气对COVID-19患者PPC的影响.
■在手术前30天内感染COVID-19的患者是回顾性的。将患者分为两组：驱动压力引导肺保护性通气策略组（LPVS组）和常规机械通气组（对照组）。通过最近邻方法的逻辑回归使用所选变量的倾向得分匹配。结果是麻醉后监护病房中PPC和低氧血症的发生率。
■两组之间的基线数据没有显着差异（P>0.05）。PPC的发生率（12.73％vs36.36％，χ2=7.068,P=0.008)和低氧血症[18.18%vs38.18%,χ2=4.492,P=0.034],LPVS组肺超声评分[4.68±1.60vs8.39±1.87,t=8.383,P<0.001]低于对照组。PEEP,LPVS组的气道压力和平台压高于对照组,但驱动压力和潮气量低于对照组，差异有统计学意义(P<0.05)。
■以最小驱动压力为指导的个性化PEEP通气策略可以改善COVID-19手术患者的氧合并降低PPC的发生率。
■在手术前30天内感染COVID-19的患者是回顾性的。将患者分为两组：驱动压力引导肺保护性通气策略组（LPVS组）和常规机械通气组（对照组）。通过最近邻方法的逻辑回归使用所选变量的倾向得分匹配。结果是麻醉后监护病房中PPC和低氧血症的发生率。
■两组之间的基线数据没有显着差异（P>0.05）。PPC的发生率（12.73％vs36.36％，χ2=7.068,P=0.008)和低氧血症[18.18%vs38.18%,χ2=4.492,P=0.034],LPVS组肺超声评分[4.68±1.60vs8.39±1.87,t=8.383,P<0.001]低于对照组。PEEP,LPVS组的气道压力和平台压高于对照组,但驱动压力和潮气量低于对照组，差异有统计学意义(P<0.05)。
■以最小驱动压力为指导的个性化PEEP通气策略可以改善COVID-19手术患者的氧合并降低PPC的发生率。
