根据两种不同方法检测患者在早期不同步脱机对其患病率及预后的影响
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Prevalence and Prognosis Impact of Patient–Ventilator Asynchrony in Early Phase of Weaning according to Two Detection Methods
背景与目的
患者与呼吸机不同步会导致一个不好的结果。然而患者在早期不同步脱机时，其严重性和发病率从未被明确地描述过。 本文首要目的是评估影响预后以及不同步脱机的相关因素。其次是根据两种检测方法来比较不同步的发生率:一种是对信号的视觉检查，另一种集成了隔膜的肌电活动的计算机化方法。
方 法
这是一项关于多中心随机对照试验的辅助研究，比较神经调节的辅助通气和压力支持通气。从控制通气转换后用上述两种方法分别在12,24,36和48小时对患者进行部分通气模式。不同步指数大于或等于10%定义为严重的不同步。
结 果
总共103例患者的平均持续时间为5天(四分位范围，3至9天)。无论采用何种方法进行量化，呼吸机不同步的程度对危重病人的结果没有影响。并且没有任何因素与严重的不同步有关。当基于流动和压力的量化时，异步的流行率明显降低，而不是基于隔膜的肌电活动，在0.3 min1(四分位范围，0.2到0.8米-1)和4.7米-1(四分位范围，3.2-7.7 min-1;分别为P < 0.0001)。
结 论
根据检测的定义和方法略有不同，但均显示部分通气模式的患者在早期脱机，不良临床结果与严重不同步脱机并无关联。
原始文献摘要
Rollanddebord C, Bureau C, Poitou T, et al. Prevalence and Prognosis Impact of Patient-Ventilator Asynchrony in Early Phase of Weaning According to Two Detection Methods.[J]. Anesthesiology, 2017:
1.
Background: Patient–ventilator asynchrony is associated with a poorer outcome. The prevalence and severity of asynchrony during the early phase of weaning has never been specifically described. The authors’ first aim was to evaluate the prognosis impact and the factors associated with asynchrony. Their second aim was to compare the prevalence of asynchrony according to two methods of detection: a visual inspection of signals and a computerized method integrating electromyographic activity of the diaphragm.
Methods: This was an ancillary study of a multicenter, randomized controlled trial comparing neurally adjusted ventilatory assist to pressure support ventilation. Asynchrony was quantified at 12, 24, 36, and 48 h after switching from controlled ventilation to a partial mode of ventilatory assistance according to the two methods. An asynchrony index greater than or equal to 10% defined severe asynchrony.
rquartile range, 3.2 to 7.7 min–1; P < 0.0001), respectively.
Results: A total of 103 patients ventilated for a median duration of 5 days (interquartile range, 3 to 9 days) were included. Whatever the method used for quantification, severe patient–ventilator asynchrony was not associated with an alteration of the outcome. No factor was associated with severe asynchrony. The prevalence of asynchrony was significantly lower when the quantification was based on flow and pressure than when it was based on the electromyographic activity of the diaphragm at 0.3 min–1 (interquartile range, 0.2 to 0.8 min–1) and 4.7 min–1 (inteABSTRACT
Conclusions: During the early phase of weaning in patients receiving a partial ventilatory mode, severe patient–ventilator asynchrony was not associated with adverse clinical outcome, although the prevalence of patient–ventilator asynchrony varies according to the definitions and methods used for detection.
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