PDF(Pubmed)
Abstract：
UNASSIGNED: Ventilator-induced lung injury (VILI) presents a grave risk to acute respiratory failure patients undergoing mechanical ventilation. Low tidal volume (LTV) ventilation has been advocated as a protective strategy against VILI. However, the effectiveness of limited driving pressure (plateau pressure minus positive end-expiratory pressure) remains unclear.
UNASSIGNED: This study evaluated the efficacy of LTV against limited driving pressure in preventing VILI in adults with respiratory failure.
UNASSIGNED: A single-centre, prospective, open-labelled, randomized controlled trial.
UNASSIGNED: This study was executed in medical intensive care units at Siriraj Hospital, Mahidol University, Bangkok, Thailand. We enrolled acute respiratory failure patients undergoing intubation and mechanical ventilation. They were randomized in a 1:1 allocation to limited driving pressure (LDP; ⩽15 cmH2O) or LTV (⩽8 mL/kg of predicted body weight). The primary outcome was the acute lung injury (ALI) score 7 days post-enrolment.
UNASSIGNED: From July 2019 to December 2020, 126 patients participated, with 63 each in the LDP and LTV groups. The cohorts had the mean (standard deviation) ages of 60.5 (17.6) and 60.9 (17.9) years, respectively, and they exhibited comparable baseline characteristics. The primary reasons for intubation were acute hypoxic respiratory failure (LDP 49.2%, LTV 63.5%) and shock-related respiratory failure (LDP 39.7%, LTV 30.2%). No significant difference emerged in the primary outcome: the median (interquartile range) ALI scores for LDP and LTV were 1.75 (1.00-2.67) and 1.75 (1.25-2.25), respectively (p = 0.713). Twenty-eight-day mortality rates were comparable: LDP 34.9% (22/63), LTV 31.7% (20/63), relative risk (RR) 1.08, 95% confidence interval (CI) 0.74-1.57, p = 0.705. Incidences of newly developed acute respiratory distress syndrome also aligned: LDP 14.3% (9/63), LTV 20.6% (13/63), RR 0.81, 95% CI 0.55-1.22, p = 0.348.
UNASSIGNED: In adults with acute respiratory failure, the efficacy of LDP and LTV in averting lung injury 7 days post-mechanical ventilation was indistinguishable.
UNASSIGNED: The study was registered with the ClinicalTrials.gov database (identification number NCT04035915).
Limited breathing pressure or low amount of air given to the lung; which one is better for adults who need breathing help by ventilator machineWe conducted this research at Siriraj Hospital in Bangkok, Thailand, aiming to compare two ways of helping patients with breathing problems. We studied 126 patients who were randomly put into two groups. One group received a method where the pressure during breathing was limited (limited driving pressure: LDP), and the other group got a method where the amount of air given to the lungs was kept low (low tidal volume: LTV). We checked how bad the lung injury was at seven days later. The results showed that there was no difference between the two methods. Both ways of helping patients breathe had similar outcomes, and neither was significantly better than the other in preventing lung problems. The study suggests that both approaches work about the same for patients who need help with breathing using a machine.
UNASSIGNED: This study evaluated the efficacy of LTV against limited driving pressure in preventing VILI in adults with respiratory failure.
UNASSIGNED: A single-centre, prospective, open-labelled, randomized controlled trial.
UNASSIGNED: This study was executed in medical intensive care units at Siriraj Hospital, Mahidol University, Bangkok, Thailand. We enrolled acute respiratory failure patients undergoing intubation and mechanical ventilation. They were randomized in a 1:1 allocation to limited driving pressure (LDP; ⩽15 cmH2O) or LTV (⩽8 mL/kg of predicted body weight). The primary outcome was the acute lung injury (ALI) score 7 days post-enrolment.
UNASSIGNED: From July 2019 to December 2020, 126 patients participated, with 63 each in the LDP and LTV groups. The cohorts had the mean (standard deviation) ages of 60.5 (17.6) and 60.9 (17.9) years, respectively, and they exhibited comparable baseline characteristics. The primary reasons for intubation were acute hypoxic respiratory failure (LDP 49.2%, LTV 63.5%) and shock-related respiratory failure (LDP 39.7%, LTV 30.2%). No significant difference emerged in the primary outcome: the median (interquartile range) ALI scores for LDP and LTV were 1.75 (1.00-2.67) and 1.75 (1.25-2.25), respectively (p = 0.713). Twenty-eight-day mortality rates were comparable: LDP 34.9% (22/63), LTV 31.7% (20/63), relative risk (RR) 1.08, 95% confidence interval (CI) 0.74-1.57, p = 0.705. Incidences of newly developed acute respiratory distress syndrome also aligned: LDP 14.3% (9/63), LTV 20.6% (13/63), RR 0.81, 95% CI 0.55-1.22, p = 0.348.
UNASSIGNED: In adults with acute respiratory failure, the efficacy of LDP and LTV in averting lung injury 7 days post-mechanical ventilation was indistinguishable.
UNASSIGNED: The study was registered with the ClinicalTrials.gov database (identification number NCT04035915).
Limited breathing pressure or low amount of air given to the lung; which one is better for adults who need breathing help by ventilator machineWe conducted this research at Siriraj Hospital in Bangkok, Thailand, aiming to compare two ways of helping patients with breathing problems. We studied 126 patients who were randomly put into two groups. One group received a method where the pressure during breathing was limited (limited driving pressure: LDP), and the other group got a method where the amount of air given to the lungs was kept low (low tidal volume: LTV). We checked how bad the lung injury was at seven days later. The results showed that there was no difference between the two methods. Both ways of helping patients breathe had similar outcomes, and neither was significantly better than the other in preventing lung problems. The study suggests that both approaches work about the same for patients who need help with breathing using a machine.
摘要：
■呼吸机引起的肺损伤（VILI）对接受机械通气的急性呼吸衰竭患者构成严重风险。低潮气量（LTV）通风已被提倡为针对VILI的保护策略。然而,有限驱动压(平台压减去呼气末正压)的有效性尚不清楚.
■这项研究评估了LTV对抗有限驱动压力在预防呼吸衰竭成人VILI中的功效。
■单中心，prospective,开放标签，随机对照试验。
■这项研究是在Siriraj医院的重症监护病房进行的，Mahidol大学,曼谷,泰国。我们招募了接受插管和机械通气的急性呼吸衰竭患者。他们以1：1的比例随机分配给有限的驾驶压力（LDP;15cmH2O）或LTV（8mL/kg的预测体重）。主要结果是入组后7天的急性肺损伤（ALI）评分。
■从2019年7月到2020年12月，126名患者参加了自民党和LTV集团各63人。队列的平均（标准差）年龄为60.5（17.6）和60.9（17.9）岁，分别,他们表现出可比的基线特征。插管的主要原因是急性低氧性呼吸衰竭（LDP49.2%，LTV63.5％）和休克相关的呼吸衰竭（LDP39.7％，LTV30.2%）。主要结局没有显着差异：LDP和LTV的ALI评分中位数（四分位距）分别为1.75（1.00-2.67）和1.75（1.25-2.25），分别（p=0.713）。28天死亡率相当：自民党34.9%（22/63），LTV31.7%（20/63），相对风险（RR）1.08，95%置信区间（CI）0.74-1.57，p=0.705。新发展的急性呼吸窘迫综合征的发病率也一致：LDP14.3％（9/63），LTV20.6%（13/63），RR0.81，95%CI0.55-1.22，p=0.348。
■在患有急性呼吸衰竭的成年人中，LDP和LTV在避免机械通气后7天肺损伤方面的疗效难以区分.
■该研究已在ClinicalTrials.gov数据库中注册（标识号NCT04035915）。
有限的呼吸压力或给予肺部的少量空气；哪一种对需要呼吸机呼吸帮助的成年人更好我们在曼谷的Siriraj医院进行了这项研究，泰国,旨在比较两种帮助呼吸困难患者的方法。我们研究了126例随机分为两组的患者。一组接受了一种方法，其中呼吸期间的压力是有限的（有限的驱动压力：LDP），另一组采用了一种方法，即给予肺部的空气量保持较低（低潮气量：LTV）。七天后，我们检查了肺损伤的严重程度。结果表明，两种方法没有差异。两种帮助患者呼吸的方法都有相似的结果，在预防肺部问题方面，两者都没有明显优于另一个。该研究表明，两种方法对于需要使用机器进行呼吸帮助的患者来说是相同的。
■这项研究评估了LTV对抗有限驱动压力在预防呼吸衰竭成人VILI中的功效。
■单中心，prospective,开放标签，随机对照试验。
■这项研究是在Siriraj医院的重症监护病房进行的，Mahidol大学,曼谷,泰国。我们招募了接受插管和机械通气的急性呼吸衰竭患者。他们以1：1的比例随机分配给有限的驾驶压力（LDP;
■从2019年7月到2020年12月，126名患者参加了自民党和LTV集团各63人。队列的平均（标准差）年龄为60.5（17.6）和60.9（17.9）岁，分别,他们表现出可比的基线特征。插管的主要原因是急性低氧性呼吸衰竭（LDP49.2%，LTV63.5％）和休克相关的呼吸衰竭（LDP39.7％，LTV30.2%）。主要结局没有显着差异：LDP和LTV的ALI评分中位数（四分位距）分别为1.75（1.00-2.67）和1.75（1.25-2.25），分别（p=0.713）。28天死亡率相当：自民党34.9%（22/63），LTV31.7%（20/63），相对风险（RR）1.08，95%置信区间（CI）0.74-1.57，p=0.705。新发展的急性呼吸窘迫综合征的发病率也一致：LDP14.3％（9/63），LTV20.6%（13/63），RR0.81，95%CI0.55-1.22，p=0.348。
■在患有急性呼吸衰竭的成年人中，LDP和LTV在避免机械通气后7天肺损伤方面的疗效难以区分.
■该研究已在ClinicalTrials.gov数据库中注册（标识号NCT04035915）。
有限的呼吸压力或给予肺部的少量空气；哪一种对需要呼吸机呼吸帮助的成年人更好我们在曼谷的Siriraj医院进行了这项研究，泰国,旨在比较两种帮助呼吸困难患者的方法。我们研究了126例随机分为两组的患者。一组接受了一种方法，其中呼吸期间的压力是有限的（有限的驱动压力：LDP），另一组采用了一种方法，即给予肺部的空气量保持较低（低潮气量：LTV）。七天后，我们检查了肺损伤的严重程度。结果表明，两种方法没有差异。两种帮助患者呼吸的方法都有相似的结果，在预防肺部问题方面，两者都没有明显优于另一个。该研究表明，两种方法对于需要使用机器进行呼吸帮助的患者来说是相同的。
