Ventilator settings and outcome of respiratory failure in chronic interstitial lung disease
Ventilator settings and outcome of respiratory failure in chronic interstitial lung disease
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DOI：
10.1378/chest.07-1481
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发表时间：
2008-05-01
期刊：
影响因子：
9.6
通讯作者：
Gajic, Ognjen
中科院分区：
文献类型：
--
作者：
Fernandez-Perez, Evans R.;Yilmaz, Murat;Gajic, Ognjen
背景资料：虽然间质性肺疾病（ILD）患者可能特别容易发生呼吸机诱导的肺损伤，但尚未对这组患者的呼吸机策略进行研究。目的：描述ILD和急性呼吸衰竭患者的临床病程和预后与呼吸机参数的关系。我们回顾性地确定了一组在同一机构入住5个ICU的ILD通气患者。我们分析了人口统计学数据、肺功能检查结果、疾病严重程度和进入ICU后最初24小时的持续通气参数。主要结果为出院生存率和1年生存率。主要结果：94例ILD患者中，44例（47%）存活至出院，39例（41%）存活至1年。术后死亡的可能性较小，病情严重程度较高，在较高的气道压力和较低的潮气量下进行通气。20例患者尝试呼气末正压（PEEP）> 10 cm H2O的阶跃变化，导致平台压升高（中位差异，+ 16 em H2O;四分位距[IQR]，9 - 24 cm 1120）和呼吸系统顺应性降低（中位差异，-0.28 mL/kg/cm H2O; IQR，-0.43至-0.13 mL/kg/cm H2O）。考克斯比例风险模型显示高PEEP（风险比，4.72; 95%置信区间[CI]，2.06至11.15），急性生理学和慢性健康状况评估（APACHE）III评分预测死亡率（风险比1.33; 95% CI，1.18 - 1.50），年龄（风险比，1.03; 95% CI，1 - 1.05），和低PaO 2/吸入氧分数比结论：疾病严重程度和高PEEP设置均与接受机械通气的ILD患者生存率降低相关。
Background: While patients with interstitial lung disease (ILD) may be particularly susceptible to ventilator-induced lung injury, ventilator strategies have not been studied in this group of patients.Purpose: To describe the clinical course and outcome of patients with ILD and acute respiratory failure in relation to ventilatory parameters.Methods: We retrospectively identified a cohort of ventilated patients with ILD who had been admitted to five ICUs at a single institution. We analyzed demographic data, pulmonary function test results, severity of illness, and the parameters of continuous ventilation for the initial 24 h after admission to the ICU. Primary outcomes were survival to hospital discharge and 1-year survival.Main results: Of 94 patients with ILD, 44 (47%) survived to hospital discharge and 39 (41%) were alive at I year. Nonsurvivors were less likely to be postoperative, had higher severity of illness, and were ventilated at higher airway pressures and lower tidal volumes. Step changes in positive end-expiratory pressure (PEEP) of > 10 cm H2O were attempted in 20 patients and resulted in an increase in plateau pressure (median difference, + 16 em H2O; interquartile range [IQR], 9 to 24 cm 1120) and a decrease in respiratory system compliance (median difference, -0.28 mL/kg/cm H2O; IQR, - 0.43 to - 0.13 mL/kg/cm H2O). The Cox proportional hazards model revealed that high PEEP (hazard ratio, 4.72; 95% confidence interval [CI], 2.06 to 11.15), acute physiology and chronic health evaluation (APACHE) III score predicted mortality (hazard ratio 1.33; 95% CI, 1.18 to 1.50), age (hazard ratio, 1.03; 95% CI, 1 to 1.05), and low PaO2/fraction of inspired oxygen ratio (hazard ratio, 0.96; 95% CI, 0.92 to 0.99) to be independent determinants of survival.Conclusion: Both severity of illness and high PEEP settings are associated with the decreased survival of patients with ILD who are receiving mechanical ventilation.