Ventilation strategies in cardiogenic shock: insights from the FRENSHOCK observational registry.

IF 3.8 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Research in Cardiology Pub Date : 2024-10-23 DOI:10.1007/s00392-024-02551-x

Kim Volle, Hamid Merdji, Vincent Bataille, Nicolas Lamblin, François Roubille, Bruno Levy, Sebastien Champion, Pascal Lim, Francis Schneider, Vincent Labbe, Hadi Khachab, Jeremy Bourenne, Marie-France Seronde, Guillaume Schurtz, Brahim Harbaoui, Gerald Vanzetto, Charlotte Quentin, Nicolas Combaret, Benjamin Marchandot, Benoit Lattuca, Caroline Biendel, Guillaume Leurent, Laurent Bonello, Edouard Gerbaud, Etienne Puymirat, Eric Bonnefoy, Nadia Aissaoui, Clément Delmas

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引用次数: 0

Abstract

Background: Despite scarce data, invasive mechanical ventilation (MV) is widely suggested as first-line ventilatory support in cardiogenic shock (CS) patients. We assessed the real-life use of different ventilation strategies in CS and their influence on short and mid-term prognosis.

Methods: FRENSHOCK was a prospective registry including 772 CS patients from 49 centers in France. Patients were categorized into three groups according to the ventilatory supports during hospitalization: no mechanical ventilation group (NV), non-invasive ventilation alone group (NIV), and invasive mechanical ventilation group (MV). We compared clinical characteristics, management, and occurrence of death and major adverse event (MAE) (death, heart transplantation or ventricular assist device) at 30 days and 1 year between the three groups.

Results: Seven hundred sixty-eight patients were included in this analysis. Mean age was 66 years and 71% were men. Among them, 359 did not receive any ventilatory support (46.7%), 118 only NIV (15.4%), and 291 MV (37.9%). MV patients presented more severe CS with more skin mottling, higher lactate levels, and higher use of vasoactive drugs and mechanical circulatory support. MV was associated with higher mortality and MAE at 30 days (HR 1.41 [1.05-1.90] and 1.52 [1.16-1.99] vs NV). No difference in mortality (HR 0.79 [0.49-1.26]) or MAE (HR 0.83 [0.54-1.27]) was found between NIV patients and NV patients. Similar results were found at 1-year follow-up.

Conclusions: Our study suggests that using NIV is safe in selected patients with less profound CS and no other MV indication. NCT02703038.

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心源性休克的通气策略：FRENSHOCK 观察登记的启示。

背景：尽管数据稀少，但有创机械通气（MV）被广泛建议作为心源性休克（CS）患者的一线通气支持。我们评估了不同通气策略在 CS 中的实际使用情况及其对短期和中期预后的影响：FRENSHOCK 是一项前瞻性登记项目，包括来自法国 49 个中心的 772 名 CS 患者。根据住院期间的通气支持将患者分为三组：无机械通气组（NV）、单纯无创通气组（NIV）和有创机械通气组（MV）。我们比较了三组患者的临床特征、管理、30 天和 1 年后的死亡和主要不良事件（MAE）发生情况（死亡、心脏移植或心室辅助装置）：本次分析共纳入了 768 名患者。平均年龄为 66 岁，71% 为男性。其中，359 人未接受任何呼吸支持（46.7%），118 人仅接受 NIV（15.4%），291 人接受 MV（37.9%）。MV 患者的 CS 表现更严重，皮肤斑驳更多，乳酸水平更高，血管活性药物和机械循环支持的使用率更高。MV 与较高的死亡率和 30 天 MAE 相关（HR 1.41 [1.05-1.90] 和 1.52 [1.16-1.99] vs NV）。NIV 患者和 NV 患者的死亡率（HR 0.79 [0.49-1.26]）或 MAE（HR 0.83 [0.54-1.27]）没有差异。随访 1 年也发现了类似的结果：结论：我们的研究表明，NIV对于某些CS程度较轻且无其他MV适应症的患者是安全的。NCT02703038。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Research in Cardiology 医学-心血管系统

CiteScore

11.40

自引率

4.00%

发文量

140

审稿时长

4-8 weeks

期刊介绍： Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery. As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.