Timing of invasive mechanic ventilation in critically ill patients with coronavirus disease 2019
Timing of invasive mechanic ventilation in critically ill patients with coronavirus disease 2019
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DOI：
10.1097/ta.0000000000002939
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发表时间：
2020-12-01
影响因子：
3.4
通讯作者：
Zhao, Yan
中科院分区：
文献类型：
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作者：
Zhang, Qian;Shen, Jun;Zhao, Yan
背景有创机械通气（IMV）是2019冠状病毒病（COVID-19）危重患者的救命策略。我们的目的是报告武汉市重症患者接受IMV的病例系列，并讨论这些患者的IMV时机。方法回顾性分析2020年1月1日至3月10日中南医院急诊重症监护室和武汉协和医院隔离病房收治的657例患者的资料。收集了40例需要进行IMV治疗的COVID-19患者在不同时间点的所有病历，包括基线（入院时）、接受IMV治疗前、死亡或出院前。结果40例新冠肺炎合并IMV患者中，死亡31例，存活出院9例。中位年龄为70岁（四分位数间距[IQR]， 62-76岁），非幸存者年龄大于幸存者。从无创机械通气（NIV）或高流量鼻插管氧疗（HFNC）到插管的中位时间IMV幸存者为7小时（IQR， 2-42小时），IMV非幸存者为54小时（IQR， 28-143小时）。我们观察到，当从NIV/HFNC到插管的时间间隔小于50小时（约2日历天），并且急性生理和慢性健康评估II （APACHE II）评分小于10或肺炎严重程度指数（PSI）评分小于100时，死亡率可降至60%或更低。从NIV/HFNC到插管间隔时间过长以及插管前APACHE II和PSI水平高与危重患者的高死亡率相关。在治疗过程中，多器官损伤在这些非幸存者中很常见。结论对于符合IMV指征的危重患者，NIV/HFNC术后早期初始插管可能对降低病死率有积极作用。考虑APACHE II和PSI评分可能有助于医生决定插管时间以减少随后的死亡率。
BackgroundInvasive mechanical ventilation (IMV) is a lifesaving strategy for critically ill patients with coronavirus disease 2019 (COVID-19). We aim to report the case series of critical patients receiving IMV in Wuhan and to discuss the timing of IMV in these patients. MethodsData of 657 patients admitted to emergency intensive care unit of Zhongnan Hospital and isolated isolation wards of Wuhan Union Hospital from January 1 to March 10, 2020, were retrospectively reviewed. All medical records of 40 COVID-19 patients who required IMV were collected at different time points, including baseline (at admission), before receiving IMV, and before death or hospital discharge. ResultsAmong 40 COVID-19 patients with IMV, 31 died, and 9 survived and was discharged. The median age was 70 years (interquartile range [IQR], 62-76 years), and nonsurvivors were older than survivors. The median period from the noninvasive mechanic ventilation (NIV) or high-flow nasal cannula oxygen therapy (HFNC) to intubation was 7 hours (IQR, 2-42 hours) in IMV survivors and 54 hours (IQR, 28-143 hours) in IMV nonsurvivors. We observed that, when the time interval from NIV/HFNC to intubation was less than 50 hours (about 2 calendar days), together with Acute Physiology and Chronic Health Evaluation II (APACHE II) score of less than 10 or pneumonia severity index (PSI) score of less than 100, mortality can be reduced to 60% or less. Prolonged interval from NIV/HFNC to intubation and high levels of APACHE II and PSI before intubation were associated with higher mortality in critically ill patients. Multiple organ damage was common among these nonsurvivors in the course of treatment. ConclusionEarly initial intubation after NIV/HFNC might have a beneficial effect in reducing mortality for critically ill patients meeting IMV indication. Considering APACHE II and PSI scores might help physicians in decision making about timing of intubation for curbing subsequent mortality.