Earlyextubationfollowedbyimmediatenoninvasiveventilationvs.standardextubationinhypoxemicpatients:arandomizedclinicaltrial
RosannaVaschetto,FedericoLonghini,PaoloPersona,CarloOri,GiuliaStefani,SongqiaoLiu,YangYi,WeihuaLu,TaoYu,XiaomingLuo,RuiTang,MaoqinLi,JiaqiongLi,GianmariaCammarota,AndreaBruni,EugenioGarofalo,ZhaochenJin,JunYan,RuiqiangZheng,JingjingYin,StefaniaGuido,FrancescoDellaCorte,TizianoFontana,CesareGregoretti,AndreaCortegiani,AntoninoGiarratano,ClaudiaMontagnini,SilvioCavuto,HaiboQiuandPaoloNavalesi
摘要
Purpose:Noninvasiveventilation(NIV)mayfacilitatewithdrawalofinvasivemechanicalventilation(i-MV)andshortenintensivecareunit(ICU)lengthofstay(LOS)inhypercapnicpatients,whiledataarelackingonhypoxemicpatients.WeaimtodeterminewhetherNIVafterearlyextubationreducesthedurationofi-MVandICULOSinpatientsrecoveringfromhypoxemicacuterespiratoryfailure.
目的：无创通气（NIV）可有助于高碳酸血症患者脱离有创机械通气（i-MV）并缩短在重症医学科的（ICU）住院时间（LOS），而低氧血症患者则缺乏相关数据。我们旨在确定早期拔管后序贯NIV是否能减少从低氧性急性呼吸衰竭患者的i-MV时间和ICULOS。
Methods:Highlyselectednon-hypercapnichypoxemicpatientswererandomlyassignedtoreceiveNIVafterearlyorstandardextubation.Co-primaryendpointsweredurationofi-MVandICULOS.Secondaryendpointsweretreatmentfailure,severeevents(hemorrhagic,septic,cardiac,renalorneurologicepisodes,pneumothoraxorpulmonaryembolism),ventilator-associatedpneumonia(VAP)ortracheobronchitis(VAT),tracheotomy,percentofpatientsreceivingsedationafterstudyenrollment,hospitalLOS,andICUandhospitalmortality.
方法：高度选择非高碳酸血症低氧血症患者，随机分为早期拔管后接受NIV和标准拔管两组。共同主要终点是I-MV的时间和ICULOS。次要终点为治疗失败、严重事件（出血、败血症、心脏、肾脏或神经系统事件、气胸或肺栓塞）、呼吸机相关性肺炎（VAP）或气管支气管炎（VAT）、气管切开术、研究入组后接受镇静治疗的患者百分比、医院LOS、ICU和医院死亡率。
Results:Weenrolledconsecutivepatients,65treatmentsand65controls.Durationofi-MVwasshorterinthetreatmentgroupthanforcontrols[4.0(3.0–7.0)vs.5.5(4.0–9.0)days,respectively,p=0.],whileICULOSwasnotsignificantlydierent[8.0(6.0–12.0)vs.9.0(6.5–12.5)days,respectively(p=0.)].IncidenceofVATorVAP(9%vs.25%,p=0.),rateofpatientsrequiringinfusionofsedativesafterenrollment(57%vs.85%,p=0.),andhospitalLOS,20(13–32)vs.27(18–39)days(p=0.)wereallsignificantlyreducedinthetreatmentgroup中科白癜风专家寒假会诊法国敏柏宁敏白灵北京
