Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask -: A randomized controlled trial
Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask -: A randomized controlled trial
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DOI：
10.1001/jama.284.18.2352
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发表时间：
2000-11-08
影响因子：
120.7
通讯作者：
Brochard, L
中科院分区：
文献类型：
--
作者：
Delclaux, C;L'Her, E;Brochard, L
背景 连续气道正压通气 (CPAP) 被广泛使用，因为人们相信它可以减少急性低氧血症性呼吸功能不全患者对插管和机械通气的需要。目的 比较 CPAP 与标准氧疗对急性低氧性、非高碳酸血症性呼吸功能不全患者的生理效应和临床疗效。设计、设置和患者 对 123 名连续入院的成年患者进行随机、隐蔽和非盲试验。 1997 年 9 月至 1999 年 1 月期间，由于双侧肺水肿，PaO2/FIO2 比值为 300 mm Hg 或更低的 6 个重症监护病房（n=102 患有急性肺损伤，n=21 患有心脏病）。 干预措施 患者被随机分配接受单独氧疗（n=61）或氧疗加 CPAP（n=62）。 主要结果指标 PaO2/FIO2 比值改善，研究期间任何时间的气管插管率、不良事件、住院时间、死亡率和通气辅助持续时间，比较 CPAP 治疗组和标准治疗组。 结果 在 CPAP 治疗组和标准治疗组中，呼吸衰竭的原因（肺炎，分别为 54% 和 55%）、心脏病（33% 和 35%）、入院时的严重程度和低氧血症（中位数 [5-95%]） PaO2/FIO2 比率，140 [59-288] mm Hg vs 148 [62-283] mm Hg；P=.43）分布相似。治疗1小时后，对治疗的主观反应（P
Context Continuous positive airway pressure (CPAP) is widely used in the belief that it may reduce the need for intubation and mechanical ventilation in patients with acute hypoxemic respiratory insufficiency.Objective To compare the physiologic effects and the clinical efficacy of CPAP vs standard oxygen therapy in patients with acute hypoxemic, nonhypercapnic respiratory insufficiency.Design, Setting, and Patients Randomized, concealed, and unblinded trial of 123 consecutive adult patients who were admitted to 6 intensive care units between September 1997 and January 1999 with a PaO2/FIO2 ratio of 300 mm Hg or less due to bilateral pulmonary edema (n=102 with acute lung injury and n=21 with cardiac disease).Interventions Patients were randomly assigned to receive oxygen therapy alone (n=61) or oxygen therapy plus CPAP (n=62).Main Outcome Measures Improvement in PaO2/FIO2 ratio, rate of endotracheal intubation at any time during the study, adverse events, length of hospital stay, mortality, and duration of ventilatory assistance, compared between the CPAP and standard treatment groups.Results Among the CPAP vs standard therapy groups, respectively, causes of respiratory failure (pneumonia, 54% and 55%), presence of cardiac disease (33% and 35%), severity at admission, and hypoxemia (median [5th-95th percentile] PaO2/FIO2 ratio, 140 [59-288] mm Hg vs 148 [62-283] mm Hg; P=.43) were similarly distributed. After 1 hour of treatment, subjective responses to treatment (P