Mechanical Ventilation and ARDS in the ED A Multicenter, Observational, Prospective, Cross-sectional Study
Mechanical Ventilation and ARDS in the ED A Multicenter, Observational, Prospective, Cross-sectional Study
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DOI：
10.1378/chest.14-2476
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发表时间：
2015-08-01
期刊：
影响因子：
9.6
通讯作者：
Kollef, Marin H.
中科院分区：
文献类型：
--
作者：
Fuller, Brian M.;Mohr, Nicholas M.;Kollef, Marin H.
背景：急诊室中关于机械通气和 ARDS 的数据很少。这可能是预防和治疗的重要领域。 方法：这项研究是一项多中心、观察性、前瞻性队列研究，旨在分析急诊室的通气实践。主要结局是入院后 ARDS 的发生率。使用多变量逻辑回归来确定 ARDS 的预测因子。结果：我们分析了 219 名接受机械通气的患者，以评估 ED 通气实践。中位潮气量为 7.6 mL/kg 预测体重 (PBW)（四分位数范围，6.9-8.9），范围为 4.3 至 12.2 mL/kg PBW。 122 名患者（55.7%）使用了肺保护性通气。从急诊室入院后 ARDS 的发生率为 14.7%，平均发病时间为 2.3 天。 ARDS 的进展与疾病严重程度较高以及院前环境或转运设施中的插管有关。在急诊室的 15 名 ARDS 患者 (6.8%) 中，7 名 (46.7%) 使用了肺保护性通气。进展为 ARDS 的患者器官衰竭持续时间更长，ICU 住院时间更长，死亡率也更高。结论：无论 ARDS 状态如何，在急诊室接受机械通气的患者很少进行肺保护性通气。入院后进展为 ARDS 很常见，且发生较早，且预后较差。急诊室中存在的患者和治疗相关因素与 ARDS 相关。鉴于 ARDS 的治疗选择有限，并且从急诊室入院后发病较早，急诊室应制定预防发作和减轻严重程度的措施。
BACKGROUND: There are few data regarding mechanical ventilation and ARDS in the ED. Th is could be a vital arena for prevention and treatment.METHODS: Th is study was a multicenter, observational, prospective, cohort study aimed at analyzing ventilation practices in the ED. The primary outcome was the incidence of ARDS aft er admission. Multivariable logistic regression was used to determine the predictors of ARDS.RESULTS: We analyzed 219 patients receiving mechanical ventilation to assess ED ventilation practices. Median tidal volume was 7.6 mL/kg predicted body weight (PBW) (interquartile range, 6.9-8.9), with a range of 4.3 to 12.2 mL/kg PBW. Lung-protective ventilation was used in 122 patients (55.7%). The incidence of ARDS aft er admission from the ED was 14.7%, with a mean onset of 2.3 days. Progression to ARDS was associated with higher illness severity and intubation in the prehospital environment or transferring facility. Of the 15 patients with ARDS in the ED (6.8%), lung-protective ventilation was used in seven (46.7%). Patients who progressed to ARDS experienced greater duration in organ failure and ICU length of stay and higher mortality.CONCLUSIONS: Lung-protective ventilation is infrequent in patients receiving mechanical ventilation in the ED, regardless of ARDS status. Progression to ARDS is common aft er admission, occurs early, and worsens outcome. Patient- and treatment-related factors present in the ED are associated with ARDS. Given the limited treatment options for ARDS, and the early onset aft er admission from the ED, measures to prevent onset and to mitigate severity should be instituted in the ED.