在机械通气下撤机对胸腔积液的影响和胸腔积液的发生率
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Prevalence and Impact on Weaning of Pleural Effusion at the Time of Liberation from Mechanical Ventilation
背景与目的
重症监护患者的胸腔积液发生频繁,但撤机对胸腔积液的影响尚不清楚。
方 法
在三个重症监护病房进行了前瞻性研究,胸膜超声在首次自主呼吸试验进行,检测并量化胸腔积液(小,中,大)。撤机失败定义为自主呼吸试验失败和在48h内,拔管需要任何形式的通气支持。主要终点是根据撤机结果分析胸腔积液的发生率。
结 果
136例(37%)患者中有51例发生胸腔积液,18例(13%)患者定量为中量至大量胸腔积液。与没有或小量的胸腔积液的患者相比,中量至大量胸腔积液的患者更可能存在慢性肾衰竭(39例 7%; P = 0.01),入院的主要原因为休克(44例19%; P = 0.02 )和体重增加明显(+4 [0 to 7] kg vs. 0 [−1 to 5] kg; P = 0.02).。撤机成功和撤机失败患者的胸腔积液发生率相似(优势比为1.23; 95%CI,0.61〜2.49; P = 0.56),中度至重度胸腔积液的发生率相似(优势比为0.89; 95 %CI,0.33〜2.41; P = 1.00)。机械通气时间和ICU住院时间,在无或小量胸腔积液与中、重度胸腔积液的患者中相似。
结 论
机械通气解除时13%的患者发生明显的胸腔积液,与撤机结局无明显关系。
原始文献摘要
Martin Dres,Damien Roux,Tài Pham,et al.Prevalence and Impact on Weaning of Pleural Effusion at the Time of Liberation from Mechanical Ventilation.Anesth Analg.2017 Jun;124(6):1777-1782. doi:10.1213/ANE. 0000000000001926.
Background:Pleural effusion is frequent in intensive care unit patients, but its impact on the outcome of weaning remains unknown.
Methods: In a prospective study performed in three intensive care units, pleural ultrasound was performed at the first spontaneous breathing trial to detect and quantify pleural effusion (small, moderate, and large). Weaning failure was defined by a failed spontaneous breathing trial and/or extubation requiring any form of ventilatory support within 48 h. The primary endpoint was the prevalence of pleural effusion according to weaning outcome.
Results: Pleural effusion was detected in 51 of 136 (37%) patients and was quantified as moderate to large in 18 (13%) patients. As compared to patients with no or small pleural effusion, their counterparts were more likely to have chronic renal failure (39 vs. 7%; P = 0.01), shock as the primary reason for admission (44 vs. 19%; P = 0.02), and a greater weight gain (+4 [0 to 7] kg vs. 0 [−1 to 5] kg; P = 0.02). The prevalence of pleural effusion was similar in weaning success and weaning failure patients (odds ratio, 1.23; 95% CI, 0.61 to 2.49; P = 0.56), as was the prevalence of moderate to large pleural effusion(odds ratio, 0.89; 95% CI, 0.33 to 2.41; P = 1.00). Duration of mechanical ventilation and intensive care unit length of stay were similar between patients with no or small pleural effusion and those with moderate to large pleural effusion.
Conclusions: Significant pleural effusion was observed in 13% of patients at the time of liberation from mechanical ventilation and was not associated with an alteration of weaning outcome.
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