Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory distress syndrome
Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory distress syndrome
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DOI：
10.1164/ajrccm.164.2.2011093
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发表时间：
2001-07-15
影响因子：
24.7
通讯作者：
Matthay, MA
中科院分区：
文献类型：
--
作者：
Eisner, MD;Thompson, T;Matthay, MA
在急性肺损伤 (ALI) 和急性呼吸窘迫综合征 (ARDS) 患者中，ARDS Network 最近的一项随机对照试验表明，与传统机械通气 (12 ml/kg) 相比，低潮气量 (VT) 机械通气策略 (6 ml/kg) 可将死亡率降低 22%。在这项研究中，我们检查了参加 ARDS 网络随机对照试验的 902 名具有不同 AWARDS 临床危险因素的患者中低 VT 机械通气的相对疗效。 ALI/ARDS 的临床危险因素与死亡率的显着变化相关。脓毒症患者的死亡风险（在无辅助呼吸出院回家前）最高（43%）；患有肺炎（36%）、误吸（37%）和其他危险因素（35%）的受试者处于中等水平；创伤患者中最低 (11%) (p < 0.0001)。尽管死亡率存在这些差异，但没有证据表明低潮气量策略的疗效因临床危险因素而异（p = 0.76，呼吸机组与危险因素之间的相互作用）。也没有证据表明低潮气量通气在其他研究结果中的疗效存在差异：实现无辅助呼吸的患者比例 (p = 0.59)、无需呼吸机的天数 (p = 0.58) 或发生非肺器官衰竭 (p = 0.44)。控制人口统计和临床协变量并没有明显影响这些结果。将临床危险因素重新分类为肺部与非肺部易感病症以及感染相关与非感染相关病症后，仍然没有证据表明低潮气量通气的疗效在临床危险因素亚组之间存在差异。总之，我们没有发现任何证据表明低潮气量通气策略的疗效在 ALI/ARDS 临床危险因素亚组之间存在差异。
In patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), a recent ARDS Network randomized controlled trial demonstrated that a low tidal volume (VT) mechanical ventilation strategy (6 ml/kg) reduced mortality by 22% compared with traditional mechanical ventilation (12 ml/kg). In this study, we examined the relative efficacy Of low VT mechanical ventilation among 902 patients with different clinical risk factors for AWARDS who participated in ARDS Network randomized controlled trials. The clinical risk factor for ALI/ARDS was associated with substantial variation in mortality. The risk of death (before discharge home with unassisted breathing) was highest in patients with sepsis (43%); intermediate in subjects with pneumonia (36%), aspiration (37%), and other risk factors (35%); and lowest in those with trauma (11%) (p < 0.0001). Despite these differences in mortality, there was no evidence that the efficacy of the low VT strategy varied by clinical risk factor (p = 0.76, for interaction between ventilator group and risk factor). There was also no evidence of differential efficacy Of low VT ventilation in the other study outcomes: proportion of patients achieving unassisted breathing (p = 0.59), ventilator-free days (p = 0.58), or development of nonpulmonary organ failure (p = 0.44). Controlling for demographic and clinical covariates did not appreciably affect these results. After reclassifying the clinical risk factors as pulmonary versus nonpulmonary predisposing conditions and infection-related versus non-infection-related conditions, there was still no evidence that the efficacy Of low VT ventilation differed among clinical risk factor subgroups. In conclusion, we found no evidence that the efficacy of the low VT ventilation strategy differed among clinical risk factor subgroups for ALI/ARDS.