目的:有关流行病学的信息,术后重症监护病房(ICU)患者的通气管理和预后仍然很少.目的是测试术后通气是否与手术室通气不同。
方法:这是全球观察性拉斯维加斯研究的一项子研究,包括接受非胸外科手术的患者。在参与拉斯维加斯研究的146个研究中心中,117(80%)在术后ICU过程中报告的站点,包括通气和并发症。共同主要结果是呼吸机管理的两个关键要素,即,潮气量(VT)和呼气末正压(PEEP)。次要结果包括接受低VT通气的患者比例(LTVV,定义为中位VT<8.0ml/kgPBW的通气),以及发生术后肺部并发症(PPC)的患者比例,包括ARDS,气胸,肺炎和需要加强通气支持,ICU和住院时间,和第28天的死亡率。
结果:在手术后入住ICU的653例患者中,274例(42%)患者接收有创术后通气。术后VT中位数为8.4[7.3-9.8]ml/kg预测体重(PBW),PEEP为5[5-5]cmH2O,与术中VT中位数(8.1[7.3-8.9]ml/kgPBW;P<0.001)和PEEP(4[2-5]cmH2O;P<0.001)相比,有统计学意义,但无显著差异.术后接收LTVV的患者比例为41%。PPC率为10%。在ICU和医院的住院时间与PPC的发展无关,但发生PPC的患者住院死亡率较高(24%vs4%;P<0.001).
结论:在这项非胸部手术患者的观察性研究中,术后通气与手术室无显著差异.就像在手术室里,存在改进使用LTVV的空间。PPC的发展与死亡率相关。
OBJECTIVE: Information about epidemiology, ventilation management and outcome in postoperative intensive care unit (ICU) patients remains scarce. The objective was to test whether postoperative ventilation differs from that in the operation room.
METHODS: This was a substudy of the worldwide observational LAS VEGAS study, including patients undergoing non-thoracic surgeries. Of 146 study sites participating in the LAS VEGAS study, 117 (80%) sites reported on the postoperative ICU course, including ventilation and complications. The coprimary outcomes were two key elements of ventilator management, i.e., tidal volume (VT) and positive end-expiratory pressure (PEEP). Secondary outcomes included the proportion of patients receiving low VT ventilation (LTVV, defined as ventilation with a median VT < 8.0 ml/kg PBW), and the proportion of patients developing postoperative pulmonary complications (PPC), including ARDS, pneumothorax, pneumonia and need for escalation of ventilatory support, ICU and hospital length of stay, and mortality at day 28.
RESULTS: Of 653 patients who were admitted to the ICU after surgery, 274 (42%) patients received invasive postoperative ventilation. Median postoperative VT was 8.4 [7.3-9.8] ml/kg predicted body weight (PBW), PEEP was 5 [5-5] cm H2O, statistically significant but not meaningfully different from median intraoperative VT (8.1 [7.3-8.9] ml/kg PBW; P < 0.001) and PEEP (4 [2-5] cm H2O; P < 0.001). The proportion of patients receiving LTVV after surgery was 41%. The PPC rate was 10%. Length of stay in ICU and hospital was independent of development of a PPC, but hospital mortality was higher in patients who developed a PPC (24 versus 4%; P < 0.001).
CONCLUSIONS: In this observational study of patients undergoing non-thoracic surgeries, postoperative ventilation was not meaningfully different from that in the operating room. Like in the operating room, there is room for improved use of LTVV. Development of PPC is associated with mortality.