PDF(Pubmed)
Abstract：
UNASSIGNED: Excess tidal volume and driving pressure were associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). Still, the appropriate mechanical ventilation strategy for patients who do not have ARDS needs to be understood. This study aimed to identify risk factors for mortality in acute respiratory failure patients without ARDS.
UNASSIGNED: We included all mechanically ventilated patients who did not meet the criteria for ARDS and were admitted to the medical intensive care unit (ICU) from October 2017 to September 2018. Patients who had tracheostomy before admission, were intubated for more than 24 hours before transfer to ICU, or underwent extracorporeal membrane oxygenation within 24 hours of ICU admission were excluded. Clinical and physiologic data were recorded and compared between survived and non-survived patients.
UNASSIGNED: Of 289 patients with acute respiratory failure, 134 patients without ARDS were included; 69 (51%) died within 28 days. Demographics, principal diagnosis, and lung injury score on the first day of admission were not significantly different between survived and non-survived patients. In multivariate analysis, higher peak inspiratory pressure (PIP) during the first 3 days of admission [odds ratio (OR) 1.11, 95% confidence interval (CI): 1.01-1.22, P=0.04], higher sequential organ failure assessment score (OR 1.15, 95% CI: 1.04-1.28, P=0.008) and underlying cerebrovascular diseases (OR 7.09, 95% CI: 1.78-28.28, P=0.006) were independently associated with mortality in these patients, whereas dynamic lung compliance (Cdyn) and respiratory rate were not associated with mortality in the multivariate model.
UNASSIGNED: Mortality was high in mechanically ventilated patients without ARDS. Higher PIP is a potentially modifiable risk factor for mortality in these patients, independent of the baseline Cdyn. Underlying cerebrovascular diseases and increased disease severity are also independent factors associated with 28-day mortality.
UNASSIGNED: We included all mechanically ventilated patients who did not meet the criteria for ARDS and were admitted to the medical intensive care unit (ICU) from October 2017 to September 2018. Patients who had tracheostomy before admission, were intubated for more than 24 hours before transfer to ICU, or underwent extracorporeal membrane oxygenation within 24 hours of ICU admission were excluded. Clinical and physiologic data were recorded and compared between survived and non-survived patients.
UNASSIGNED: Of 289 patients with acute respiratory failure, 134 patients without ARDS were included; 69 (51%) died within 28 days. Demographics, principal diagnosis, and lung injury score on the first day of admission were not significantly different between survived and non-survived patients. In multivariate analysis, higher peak inspiratory pressure (PIP) during the first 3 days of admission [odds ratio (OR) 1.11, 95% confidence interval (CI): 1.01-1.22, P=0.04], higher sequential organ failure assessment score (OR 1.15, 95% CI: 1.04-1.28, P=0.008) and underlying cerebrovascular diseases (OR 7.09, 95% CI: 1.78-28.28, P=0.006) were independently associated with mortality in these patients, whereas dynamic lung compliance (Cdyn) and respiratory rate were not associated with mortality in the multivariate model.
UNASSIGNED: Mortality was high in mechanically ventilated patients without ARDS. Higher PIP is a potentially modifiable risk factor for mortality in these patients, independent of the baseline Cdyn. Underlying cerebrovascular diseases and increased disease severity are also independent factors associated with 28-day mortality.
摘要：
■潮气量和驱动压力过大与急性呼吸窘迫综合征（ARDS）患者死亡率增加相关。尽管如此，对于没有ARDS的患者,需要了解合适的机械通气策略.本研究旨在确定无ARDS的急性呼吸衰竭患者死亡的危险因素。
■我们纳入了所有不符合ARDS标准的机械通气患者，并于2017年10月至2018年9月期间入住重症监护病房（ICU）。入院前进行气管切开术的患者，在转移到ICU之前插管超过24小时，或在入住ICU24小时内接受体外膜氧合的患者被排除.记录临床和生理数据，并在存活和非存活患者之间进行比较。
■289例急性呼吸衰竭患者，包括134例无ARDS患者；69例（51％）在28天内死亡。人口统计,主要诊断,存活和非存活患者入院第一天的肺损伤评分无显著差异.在多变量分析中，入院前3天峰值吸气压（PIP）较高[比值比（OR）1.11，95％置信区间（CI）：1.01-1.22，P=0.04]，更高的序贯器官衰竭评估评分(OR1.15,95%CI:1.04-1.28,P=0.008)和基础脑血管疾病(OR7.09,95%CI:1.78-28.28,P=0.006)与这些患者的死亡率独立相关,而在多变量模型中,动态肺顺应性(Cdyn)和呼吸频率与死亡率无关.
■无ARDS的机械通气患者死亡率较高。较高的PIP是这些患者死亡的潜在可改变的危险因素，独立于基线Cdyn。基础脑血管疾病和疾病严重程度增加也是与28天死亡率相关的独立因素。
■我们纳入了所有不符合ARDS标准的机械通气患者，并于2017年10月至2018年9月期间入住重症监护病房（ICU）。入院前进行气管切开术的患者，在转移到ICU之前插管超过24小时，或在入住ICU24小时内接受体外膜氧合的患者被排除.记录临床和生理数据，并在存活和非存活患者之间进行比较。
■289例急性呼吸衰竭患者，包括134例无ARDS患者；69例（51％）在28天内死亡。人口统计,主要诊断,存活和非存活患者入院第一天的肺损伤评分无显著差异.在多变量分析中，入院前3天峰值吸气压（PIP）较高[比值比（OR）1.11，95％置信区间（CI）：1.01-1.22，P=0.04]，更高的序贯器官衰竭评估评分(OR1.15,95%CI:1.04-1.28,P=0.008)和基础脑血管疾病(OR7.09,95%CI:1.78-28.28,P=0.006)与这些患者的死亡率独立相关,而在多变量模型中,动态肺顺应性(Cdyn)和呼吸频率与死亡率无关.
■无ARDS的机械通气患者死亡率较高。较高的PIP是这些患者死亡的潜在可改变的危险因素，独立于基线Cdyn。基础脑血管疾病和疾病严重程度增加也是与28天死亡率相关的独立因素。
