Epidemiology of Mechanical Ventilation: Analysis of the SAPS 3 Database
Epidemiology of Mechanical Ventilation: Analysis of the SAPS 3 Database
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DOI：
10.1007/s00134-009-1449-9
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发表时间：
2009-05-01
影响因子：
38.9
通讯作者：
Ranieri, V. Marco
中科院分区：
文献类型：
--
作者：
Metnitz, Philipp G. H.;Metnitz, Barbara;Ranieri, V. Marco
目的：评价ICU机械通气的现状及患者的特点和预后。一项多中心、多国队列研究（SAPS 3）的预先计划亚研究纳入了来自35个国家299个重症监护病房（icu）的13322例患者，患者分为三组：无机械通气（MV）、无创通气（NIV）和有创通气（MV）。超过一半的患者（53% [CI: 52.2-53.9%]）在ICU入院时采用机械通气。有创MV期间FiO(2)、Vt和PEEP平均为50%（40-80%）、8 mL/kg实际体重（6.9-9.4 mL/kg）和5 cmH(2)O （3-6 cmH(2)O）。几例invMV患者（17.3% (CI:16.4-18.3%)）采用零PEEP通气（ZEEP）。与正压通气患者相比，这些患者经风险调整后的住院死亡率显著增加（O/E比1.12[1.05-1.18]）。所有患者中4.2% （CI: 3.8-4.5%）使用了NIV，并与改善的风险调整结果相关（OR 0.79,[0.69-0.90]）。不同icu间通气模式和通气参数设置差异显著。我们的结果提供的证据表明，一些通气模式和设置仍然可以用来反对目前的证据和建议。这包括低PaO2/FiO2比患者和低ZEEP患者的潮气量> - 8mL/kg体重的通气。即使在控制疾病严重程度后，有创机械通气与ZEEP的预后较差相关。由于我们的研究没有记录MV的适应症，所以必须谨慎看待MV设置和结果之间的关系。
To evaluate current practice of mechanical ventilation in the ICU and the characteristics and outcomes of patients receiving it.Pre-planned sub-study of a multicenter, multinational cohort study (SAPS 3).13,322 patients admitted to 299 intensive care units (ICUs) from 35 countries.None.Patients were divided into three groups: no mechanical ventilation (MV), noninvasive MV (NIV), and invasive MV. More than half of the patients (53% [CI: 52.2-53.9%]) were mechanically ventilated at ICU admission. FiO(2), Vt and PEEP used during invasive MV were on average 50% (40-80%), 8 mL/kg actual body weight (6.9-9.4 mL/kg) and 5 cmH(2)O (3-6 cmH(2)O), respectively. Several invMV patients (17.3% (CI:16.4-18.3%)) were ventilated with zero PEEP (ZEEP). These patients exhibited a significantly increased risk-adjusted hospital mortality, compared with patients ventilated with higher PEEP (O/E ratio 1.12 [1.05-1.18]). NIV was used in 4.2% (CI: 3.8-4.5%) of all patients and was associated with an improved risk-adjusted outcome (OR 0.79, [0.69-0.90]).Ventilation mode and parameter settings for MV varied significantly across ICUs. Our results provide evidence that some ventilatory modes and settings could still be used against current evidence and recommendations. This includes ventilation with tidal volumes > 8mL/kg body weight in patients with a low PaO2/FiO2 ratio and ZEEP in invMV patients. Invasive mechanical ventilation with ZEEP was associated with a worse outcome, even after controlling for severity of disease. Since our study did not document indications for MV, the association between MV settings and outcome must be viewed with caution.