Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study.
Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study.
复制标题
DOI：
10.1136/bmj.e2124
复制
发表时间：
2012-04-05
期刊：
影响因子：
--
通讯作者：
Pronovost PJ
中科院分区：
文献类型：
--
作者：
Needham DM;Colantuoni E;Mendez-Tellez PA;Dinglas VD;Sevransky JE;Dennison Himmelfarb CR;Desai SV;Shanholtz C;Brower RG;Pronovost PJ
目的探讨容量受限和压力受限(肺保护性)机械通气对急性肺损伤患者两年存活率的影响。设计前瞻性队列研究。在美国马里兰州巴尔的摩的四家医院设立了13个重症监护病房。研究对象485例连续接受机械通气的急性肺损伤患者。主要观察指标急性肺损伤发病后两年存活率。结果485名患者贡献了6240个符合条件的呼吸机设置的数据，每天测量两次(每个患者8个符合条件的呼吸机设置的中位数；其中41%坚持肺保护性通风)。在这些患者中，311人(%)在两年内死亡。在调整了总的呼吸机持续时间和其他相关变量后，每增加一台呼吸机使用肺保护性呼吸机，两年内死亡风险降低3%(危险比0.97，95%可信区间0.95-0.99，P=0.002)。与未坚持的患者相比，坚持50%肺保护性通气的典型患者两年死亡率的绝对风险降低4.0%(0.8%至7.2%，P=0.012)，100%坚持的患者两年死亡率的绝对风险降低7.8%(1.6%至14.0%，P=0.011)。结论肺保护性机械通气对急性肺损伤患者的长期生存有显著的促进作用。在常规临床实践中更多地使用肺保护性通风可以降低急性肺损伤患者的长期死亡率。试验注册诊所Trials.gov NCT00300248。
Objective To evaluate the association of volume limited and pressure limited (lung protective) mechanical ventilation with two year survival in patients with acute lung injury. Design Prospective cohort study. Setting 13 intensive care units at four hospitals in Baltimore, Maryland, USA. Participants 485 consecutive mechanically ventilated patients with acute lung injury. Main outcome measure Two year survival after onset of acute lung injury. Results 485 patients contributed data for 6240 eligible ventilator settings, as measured twice daily (median of eight eligible ventilator settings per patient; 41% of which adhered to lung protective ventilation). Of these patients, 311 (64%) died within two years. After adjusting for the total duration of ventilation and other relevant covariates, each additional ventilator setting adherent to lung protective ventilation was associated with a 3% decrease in the risk of mortality over two years (hazard ratio 0.97, 95% confidence interval 0.95 to 0.99, P=0.002). Compared with no adherence, the estimated absolute risk reduction in two year mortality for a prototypical patient with 50% adherence to lung protective ventilation was 4.0% (0.8% to 7.2%, P=0.012) and with 100% adherence was 7.8% (1.6% to 14.0%, P=0.011). Conclusions Lung protective mechanical ventilation was associated with a substantial long term survival benefit for patients with acute lung injury. Greater use of lung protective ventilation in routine clinical practice could reduce long term mortality in patients with acute lung injury. Trial registration Clinicaltrials.gov NCT00300248.
登录
查看更多内容
影响因子：
8.8
作者：
Needham, DM;Bronskill, SE;Laupacis, A
通讯作者：
Laupacis, A
影响因子：
158.5
作者：
Amato, MBP;Barbas, CSV;Carvalho, CRR
通讯作者：
Carvalho, CRR
影响因子：
3.7
作者：
Needham, Dale M.;Wang, Weiwei;Pronovost, Peter J.
通讯作者：
Pronovost, Peter J.
DOI：
10.1186/cc8848
发表时间：
2010
期刊：
Critical care (London, England)
影响因子：
--
作者：
Cuthbertson BH;Roughton S;Jenkinson D;Maclennan G;Vale L
通讯作者：
Vale L
影响因子：
158.5
作者：
Papazian, Laurent;Forel, Jean-Marie;Roch, Antoine
通讯作者：
Roch, Antoine