Adherence to Lung Protective Ventilation in Patients With Coronavirus Disease 2019.
Adherence to Lung Protective Ventilation in Patients With Coronavirus Disease 2019.
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DOI：
10.1097/cce.0000000000000512
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发表时间：
2021-08
影响因子：
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通讯作者：
Kerlin MP
中科院分区：
文献类型：
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作者：
Levy E;Scott S;Tran T;Wang W;Mikkelsen ME;Fuchs BD;Kerlin MP
先前的研究表明，急性呼吸窘迫综合征患者对肺保护性通气的依从性不佳。提供这种循证实践的一个常见障碍是诊断的不确定性。我们试图检验以下假设：2019 年冠状病毒病导致的急性呼吸窘迫综合征患者（其中急性呼吸窘迫综合征很容易被识别）比同时入院的没有 2019 年冠状病毒病的急性呼吸窘迫综合征患者更有可能接受小潮气量通气。回顾性队列研究。单一卫生系统的五家医院。研究医院临床使用的自动电子急性呼吸窘迫综合征检测仪识别出患有 2019 年冠状病毒病或 2019 年非冠状病毒病急性呼吸窘迫综合征的机械通气患者。没有任何。在 333 名 2019 冠状病毒病患者和 234 名非冠状病毒 2019 急性呼吸窘迫综合征患者中，平均初始潮气量分别为 6.4 cc/kg 预测体重和 6.8 cc/kg 预测体重。在 2019 年冠状病毒疾病队列中，在机械通气的前 72 小时内，平均有 70% 的患者潮气量小于或等于 6.5 cc/kg 预测体重，而在 2019 年非冠状病毒疾病队列中，这一比例为 52%（未经调整 p < 0.001）。在调整身高、性别、入院医院以及患者是否入住医学专业 ICU 后，2019 年冠状病毒病诊断与机械通气前 72 小时内接受小于或等于 6.5 cc/kg 预测体重的潮气量的时间百分比增加 21% 相关（95% CI，14-28%；p < 0.001）。患有 2019 年冠状病毒病的患者在机械通气的前 72 小时内坚持小潮气量通气的程度高于未患 2019 年冠状病毒病的急性呼吸窘迫综合征患者。这一人群可能提供一个机会来了解实施这种挽救生命的循证实践的促进者。
Prior studies have demonstrated suboptimal adherence to lung protective ventilation among patients with acute respiratory distress syndrome. A common barrier to providing this evidence-based practice is diagnostic uncertainty. We sought to test the hypothesis that patients with acute respiratory distress syndrome due to coronavirus disease 2019, in whom acute respiratory distress syndrome is easily recognized, would be more likely to receive low tidal volume ventilation than concurrently admitted acute respiratory distress syndrome patients without coronavirus disease 2019. Retrospective cohort study. Five hospitals of a single health system. Mechanically ventilated patients with coronavirus disease 2019 or noncoronavirus disease 2019 acute respiratory distress syndrome as identified by an automated, electronic acute respiratory distress syndrome finder in clinical use at study hospitals. None. Among 333 coronavirus disease 2019 patients and 234 noncoronavirus disease 2019 acute respiratory distress syndrome patients, the average initial tidal volume was 6.4 cc/kg predicted body weight and 6.8 cc/kg predicted body weight, respectively. Patients had tidal volumes less than or equal to 6.5 cc/kg predicted body weight for a mean of 70% of the first 72 hours of mechanical ventilation in the coronavirus disease 2019 cohort, compared with 52% in the noncoronavirus disease 2019 cohort (unadjusted p < 0.001). After adjusting for height, gender, admitting hospital, and whether or not the patient was admitted to a medical specialty ICU, coronavirus disease 2019 diagnosis was associated with a 21% higher percentage of time receiving tidal volumes less than or equal to 6.5 cc/kg predicted body weight within the first 72 hours of mechanical ventilation (95% CI, 14–28%; p < 0.001). Adherence to low tidal volume ventilation during the first 72 hours of mechanical ventilation is higher in patients with coronavirus disease 2019 than with acute respiratory distress syndrome without coronavirus disease 2019. This population may present an opportunity to understand facilitators of implementation of this life-saving evidence-based practice.