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Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: a multi-center prospective cohort study.

早期俯卧位联合 HFNC 或 NIV 治疗中重度 ARDS 的疗效和安全性: 一项多中心前瞻性队列研究。

  • 影响因子:5.02
  • DOI:10.1186/s13054-020-2738-5
  • 作者列表:"Ding L","Wang L","Ma W","He H
  • 发表时间:2020-01-30
Abstract

BACKGROUND:Previous studies suggest that prone positioning (PP) can increase PaO2/FiO2 and reduce mortality in moderate to severe acute respiratory distress syndrome (ARDS). The aim of our study was to determine whether the early use of PP combined with non-invasive ventilation (NIV) or high-flow nasal cannula (HFNC) can avoid the need for intubation in moderate to severe ARDS patients. METHODS:This prospective observational cohort study was performed in two teaching hospitals. Non-intubated moderate to severe ARDS patients were included and were placed in PP with NIV or with HFNC. The efficacy in improving oxygenation with four support methods-HFNC, HFNC+PP, NIV, NIV+PP-were evaluated by blood gas analysis. The primary outcome was the rate of intubation. RESULTS:Between January 2018 and April 2019, 20 ARDS patients were enrolled. The main causes of ARDS were pneumonia due to influenza (9 cases, 45%) and other viruses (2 cases, 10%). Ten cases were moderate ARDS and 10 cases were severe. Eleven patients avoided intubation (success group), and 9 patients were intubated (failure group). All 7 patients with a PaO2/FiO2  95%, may help avoid intubation. The PP was well tolerated, and the efficacy on PaO2/FiO2 of the four support strategies was HFNC < HFNC+PP ≤ NIV < NIV+PP. Severe ARDS patients were not appropriate candidates for HFNC/NIV+PP. TRIAL REGISTRATION:ChiCTR, ChiCTR1900023564. Registered 1 June 2019 (retrospectively registered).

摘要

背景: 既往研究提示俯卧位 (PP) 可提高 PaO2/FiO2,降低中重度急性呼吸窘迫综合征 (ARDS) 的死亡率。我们研究的目的是确定早期使用 PP 联合无创通气 (NIV) 还是高流量鼻导管 (HFNC) 可避免中重度 ARDS 患者需要插管。 方法: 这项前瞻性观察性队列研究在两家教学医院进行。纳入未插管的中重度 ARDS 患者,用 NIV 或 HFNC 置入 PP。采用血气分析评价 HFNC 、 HFNC + PP 、 NIV + PP 四种支持方法改善氧合的疗效。主要结果是插管率。 结果: 2018年1月至 2019年4月期间,20 例 ARDS 患者入组。引起 ARDS 的主要原因是流感引起的肺炎 (9 例,45%) 和其他病毒引起的肺炎 (2 例,10%)。10 例为中度 ARDS,10 例为重度 ARDS。11 例避免插管 (成功组),9 例插管 (失败组)。所有 7 例患者的 PaO2/FiO2  95%,可能有助于避免插管。PP 耐受性良好,4 种支持策略对 PaO2/FiO2 的疗效为 HFNC

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影响因子:2.87
发表时间:2020-01-28
来源期刊:Bioscience reports
DOI:10.1042/BSR20192435
作者列表:["Yu H","Luo J","Ni Y","Hu Y","Liu D","Wang M","Liang B","Liang Z"]

METHODS::Backgroud Severe pneumonia is one of the most common causes for mechanical ventilation. We aimed to early identify severe pneumonia patients with high risk of extubation failure in order to improve prognosis. Methods From April 2014 to December 2015, medical records of intubated patients with severe pneumonia in intensive care unit were retrieved from database. Patients were divided into extubation success and failure groups, and multivariate logistic regressions were performed to identify independent predictors for extubation failure. Results A total of 125 eligible patients were included, of which 82 and 43 patients had extubation success and failure, respectively. APACHE II score (odds ration (OR) 1.141, 95% confident interval (CI) 1.022-1.273, P = 0.019, cutoff at 17.5), blood glucose (OR 1.122, 95%CI 1.008-1.249, P = 0.035, cutoff at 9.87mmol/L), dose of fentanyl (OR 3.010, 95%CI 1.100-8.237, P = 0.032, cutoff at 1.135mg/d), and the need for red blood cell (RBC) transfusion (OR 2.774, 95%CI 1.062-7.252, P = 0.037) were independent risk factors for extubation failure. Conclusions In patients with severe pneumonia, APACHE II score > 17.5, blood glucose > 9.87mmol/L, fentanyl usage > 1.135mg/d, and the need for RBC transfusion might be associated with higher risk of extubation failure.

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影响因子:3.86
发表时间:2020-01-28
来源期刊:Resuscitation
DOI:10.1016/j.resuscitation.2020.01.013
作者列表:["Lundin A","Karlsson T","Herlitz J","Lundgren P","Rylander C"]

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