Utilization patterns and patient outcomes associated with use of rescue therapies in acute lung injury.
Utilization patterns and patient outcomes associated with use of rescue therapies in acute lung injury.
复制标题
与急性肺损伤救援疗法的使用相关的利用模式和患者结果。
DOI：
10.1097/ccm.0b013e3182120829
复制
发表时间：
2011
影响因子：
8.8
通讯作者：
Wiener,RendaSoylemez
中科院分区：
文献类型：
--
作者：
Walkey,AllanJ;Wiener,RendaSoylemez
目的：调查急性肺损伤患者使用急救治疗的实践模式和临床结局。设计：对来自美国国家心肺血液研究所急性呼吸窘迫综合征临床试验网络的多中心、随机、对照试验数据进行二级分析。设置：美国急性呼吸窘迫综合征临床试验网络中心的重症监护室。患者：1996年至2005年期间参加6项急性呼吸窘迫综合征临床试验网络试验的受试者。干预措施：无。测量和主要结果：2632中的166（6.3%）受试者接受了补救治疗，定义为俯卧位（97/166 [58%]）、吸入性血管扩张剂（47/166 [28%]）、高频通气（12/166 [7%]）或体外膜肺氧合（10/166 [6%]）。随着时间的推移，吸入性血管扩张剂的使用增加，而俯卧位的使用减少（趋势p值分别为0.04和0.0013）。使用补救治疗的多变量预测因素包括年龄（每10年的比值比和95%置信区间：0.88; 0.78-0.99; p=. 049）、呼气末正压（每增加5 cm H2 O的比值比：1.33; 95%可信区间，1.05-1.69; p=. 019），Pao 2/Fio 2;每5 cm H2 O增加的比值比：0. 98; 95%置信区间，0. 96 - 0. 99; p=. 017）、气道峰压（每增加5 cm H2 O的比值比：1.11; 95%可信区间，1.001-1.237; p=. 047）和研究顺序（根据随后的急性呼吸窘迫综合征临床试验网络研究的比值比：1.21; 95%置信区间，1.03-1.41; p=. 02）。对倾向评分匹配的受试者进行的考克斯比例风险分析显示，接受补救治疗的受试者与未接受补救治疗的受试者的生存率无差异（补救治疗后或索引日期后死亡的风险比，1.10; 95%置信区间，0.67-1.78; p=. 72）。在接受俯卧位与吸入性血管扩张剂的患者之间没有发现生存差异（俯卧位的倾向评分调整风险比为0.87; 95%置信区间为0.86-2.10; p=.结论：补救治疗用于氧合缺陷更严重的年轻患者。补救治疗的使用模式似乎随着时间的推移而发生变化。在观察性研究设计的范围内，我们没有发现急性肺损伤患者使用补救治疗的生存获益证据。
Objectives:To investigate the practice patterns and clinical outcomes associated with use of rescue therapies in patients with acute lung injury.Design:Secondary analysis of multicentered, randomized, controlled trial data from the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network.Setting:Intensive care units of Acute Respiratory Distress Syndrome Clinical Trials Network centers across the United States.Patients:Subjects enrolled in six Acute Respiratory Distress Syndrome Clinical Trials Network trials occurring between 1996 and 2005.Interventions:None.Measurements and Main Results:One hundred sixty-six of 2632 (6.3%) subjects received rescue therapy, defined as prone positioning (97 of 166 [58%]), inhaled vasodilators (47 of 166 [28%]), high-frequency ventilation (12 of 166 [7%]), or extracorporeal membrane oxygenation (10 of 166 [6%]). Use of inhaled vasodilators increased whereas use of prone position decreased over time (p for trend= 0.04 and 0.0013, respectively). Multivariate predictors for use of rescue therapy included age (odds ratio per 10 yrs and 95% confidence interval: 0.88; 0.78–0.99; p=. 049), positive end-expiratory pressure (odds ratio per 5-cm H 2 O increase: 1.33; 95% confidence interval, 1.05–1.69; p=. 019), Pao 2/Fio 2; odds ratio per 5-cm H 2 O increase: 0.98; 95% confidence interval, 0.96–0.99; p=. 017), peak airway pressure (odds ratio per 5-cm H 2 O increase: 1.11; 95% confidence interval, 1.001–1.237; p=. 047), and study order (odds ratio per subsequent Acute Respiratory Distress Syndrome Clinical Trials Network study: 1.21; 95% confidence interval, 1.03–1.41; p=. 02). Cox proportional hazards analysis of propensity score-matched subjects showed no difference in survival for those who received rescue therapy vs. those who did not (hazard ratio for death after rescue therapy or index date, 1.10; 95% confidence interval, 0.67–1.78; p=. 72). No differences in survival were found between those who received prone positioning vs. inhaled vasodilators (propensity score-adjusted hazard ratio for prone 0.87; 95% confidence interval, 0.86–2.10; p=. 76).Conclusions:Rescue therapies are utilized in younger patients with more severe oxygenation deficits. Patterns of rescue therapy utilization appear to be changing over time. Within the limits of an observational study design, we did not find evidence of a survival benefit with use of rescue therapies in acute lung injury.