机械通气：功率对死亡率的影响

本文由“小麻哥的日常"授权转载

摘要译文（供参考）

机械功率对无急性呼吸窘迫综合征的有创通气ICU患者死亡率的影响
背景
机械通气功率（MP）与急性呼吸窘迫综合征（ARDS）有创通气患者的预后相关。 在无ARDS的有创通气患者中是否存在类似的关联尚不确定。
目的
探讨无ARDS的ICU患者机械功率与死亡率的关系。
设计
这是一项使用三项多中心随机试验数据的个体患者数据分析。
场所
这项研究在荷兰的学术和非学术ICU中进行。
病人
162名无ARDS的有创通气患者被纳入该分析。 平均[IQR]年龄为67岁[57至75]岁，706（36%）名女性。
主要结局指标
主要结局是第28天的全因死亡率。 次要结局是第90天的全原因死亡率，以及在ICU和医院的住院时间。
结果
第28天，644名患者（33%）死亡。 第28天死亡率的危险比随着MP的增加而增加，即使在对其各个组成部分（驱动压力（P<0.001）、潮气量（P<0.0001）、呼吸频率（P<0.001）和最大气道压力（P=0.001）进行分层时也是如此。 MP与第90天的死亡率、ICU和医院的住院时间也有类似的关联。 如果对患者进行MP分层，则第28天死亡率的危险比没有显著差异，每个个体的水平都在增加。
结论
在因ARDS以外的原因接受有创通气的ICU患者中，MP与死亡率有独立的相关性。 这一发现表明，MP对其单个成分具有额外的预测价值，使MP可能成为针对这些患者的有吸引力的监测和干预措施。
原文摘要
Effect of mechanical power on mortality in invasively ventilated ICU patients without the acute respiratory distress syndrome BACKGROUND  The mechanical power of ventilation (MP) has an association with outcome in invasively ventilated patients with the acute respiratory distress syndrome (ARDS). Whether a similar association exists in invasively ventilated patients without ARDS is less certain. OBJECTIVE  To investigate the association of mechanical power with mortality in ICU patients without ARDS. DESIGN  This was an individual patient data analysis that uses the data of three multicentre randomised trials. SETTING  This study was performed in academic and nonacademic ICUs in the Netherlands. PATIENTS  One thousand nine hundred and sixty-two invasively ventilated patients without ARDS were included in this analysis. The median [IQR] age was 67 [57 to 75] years, 706 (36%) were women. MAIN OUTCOME MEASURES  The primary outcome was the all-cause mortality at day 28. Secondary outcomes were the all-cause mortality at day 90, and length of stay in ICU and hospital. RESULTS  At day 28, 644 patients (33%) had died. Hazard ratios for mortality at day 28 were higher with an increasing MP, even when stratified for its individual components (driving pressure (P < 0.001), tidal volume (P < 0.001), respiratory rate (P < 0.001) and maximum airway pressure (P = 0.001). Similar associations of mechanical power (MP) were found with mortality at day 90, lengths of stay in ICU and hospital. Hazard ratios for mortality at day 28 were not significantly different if patients were stratified for MP, with increasing levels of each individual component. CONCLUSION  In ICU patients receiving invasive ventilation for reasons other than ARDS, MP had an independent association with mortality. This finding suggests that MP holds an added predictive value over its individual components, making MP an attractive measure to monitor and possibly target in these patients.