Emanuele Rezoagli, Carla Fornari, Roberto Fumagalli, Giacomo Grasselli, Carlo Alberto Volta, Paolo Navalesi, Rihard Knafelj, Laurent Brochard, Antonio Pesenti, Tommaso Mauri, Giuseppe Foti
{"title":"叹息对急性低氧性呼吸衰竭患者死亡率的不同影响：PROTECTION 研究的启示。","authors":"Emanuele Rezoagli, Carla Fornari, Roberto Fumagalli, Giacomo Grasselli, Carlo Alberto Volta, Paolo Navalesi, Rihard Knafelj, Laurent Brochard, Antonio Pesenti, Tommaso Mauri, Giuseppe Foti","doi":"10.1186/s13613-024-01385-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Sigh breaths may impact outcomes in acute hypoxemic respiratory failure (AHRF) during assisted mechanical ventilation. We investigated whether sigh breaths may impact mortality in predefined subgroups of patients enrolled in the PROTECTION multicenter clinical trial according to: 1.the physiological response in oxygenation to Sigh (responders versus non-responders) and 2.the set levels of positive end-expiratory pressure (PEEP) (High vs. Low-PEEP). If mortality differed between Sigh and No Sigh, we explored physiological daily differences at 7-days.</p><p><strong>Results: </strong>Patients were randomized to pressure support ventilation (PSV) with Sigh (Sigh group) versus PSV with no sigh (No Sigh group). (1) Sighs were not associated with differences in 28-day mortality in responders to baseline sigh-test. Contrarily-in non-responders-56 patients were randomized to Sigh (55%) and 28-day mortality was lower with sighs (17%vs.36%, log-rank p = 0.031). (2) In patients with PEEP > 8cmH<sub>2</sub>O no difference in mortality was observed with sighs. With Low-PEEP, 54 patients were randomized to Sigh (48%). Mortality at 28-day was reduced in patients randomised to sighs (13%vs.31%, log-rank p = 0.021). These findings were robust to multivariable adjustments. Tidal volume, respiratory rate and ventilatory ratio decreased with Sigh as compared with No Sigh at 7-days. Ventilatory ratio was associated with mortality and successful extubation in both non-responders and Low-PEEP.</p><p><strong>Conclusions: </strong>Addition of Sigh to PSV could reduce mortality in AHRF non-responder to Sigh and exposed to Low-PEEP. Results in non-responders were not expected. Findings in the low PEEP group may indicate that insufficient PEEP was used or that Low PEEP may be used with Sigh. Sigh may reduce mortality by decreasing physiologic dead space and ventilation intensity and/or optimizing ventilation/perfusion mismatch.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; Identifier: NCT03201263.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"14 1","pages":"153"},"PeriodicalIF":5.7000,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456003/pdf/","citationCount":"0","resultStr":"{\"title\":\"Heterogeneous impact of Sighs on mortality in patients with acute hypoxemic respiratory failure: insights from the PROTECTION study.\",\"authors\":\"Emanuele Rezoagli, Carla Fornari, Roberto Fumagalli, Giacomo Grasselli, Carlo Alberto Volta, Paolo Navalesi, Rihard Knafelj, Laurent Brochard, Antonio Pesenti, Tommaso Mauri, Giuseppe Foti\",\"doi\":\"10.1186/s13613-024-01385-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Sigh breaths may impact outcomes in acute hypoxemic respiratory failure (AHRF) during assisted mechanical ventilation. We investigated whether sigh breaths may impact mortality in predefined subgroups of patients enrolled in the PROTECTION multicenter clinical trial according to: 1.the physiological response in oxygenation to Sigh (responders versus non-responders) and 2.the set levels of positive end-expiratory pressure (PEEP) (High vs. Low-PEEP). If mortality differed between Sigh and No Sigh, we explored physiological daily differences at 7-days.</p><p><strong>Results: </strong>Patients were randomized to pressure support ventilation (PSV) with Sigh (Sigh group) versus PSV with no sigh (No Sigh group). (1) Sighs were not associated with differences in 28-day mortality in responders to baseline sigh-test. Contrarily-in non-responders-56 patients were randomized to Sigh (55%) and 28-day mortality was lower with sighs (17%vs.36%, log-rank p = 0.031). (2) In patients with PEEP > 8cmH<sub>2</sub>O no difference in mortality was observed with sighs. With Low-PEEP, 54 patients were randomized to Sigh (48%). Mortality at 28-day was reduced in patients randomised to sighs (13%vs.31%, log-rank p = 0.021). These findings were robust to multivariable adjustments. Tidal volume, respiratory rate and ventilatory ratio decreased with Sigh as compared with No Sigh at 7-days. Ventilatory ratio was associated with mortality and successful extubation in both non-responders and Low-PEEP.</p><p><strong>Conclusions: </strong>Addition of Sigh to PSV could reduce mortality in AHRF non-responder to Sigh and exposed to Low-PEEP. Results in non-responders were not expected. Findings in the low PEEP group may indicate that insufficient PEEP was used or that Low PEEP may be used with Sigh. Sigh may reduce mortality by decreasing physiologic dead space and ventilation intensity and/or optimizing ventilation/perfusion mismatch.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; Identifier: NCT03201263.</p>\",\"PeriodicalId\":7966,\"journal\":{\"name\":\"Annals of Intensive Care\",\"volume\":\"14 1\",\"pages\":\"153\"},\"PeriodicalIF\":5.7000,\"publicationDate\":\"2024-10-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456003/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Intensive Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13613-024-01385-0\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Intensive Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13613-024-01385-0","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景：叹气可能会影响辅助机械通气期间急性低氧血症呼吸衰竭（AHRF）的预后。我们研究了叹息呼吸是否会影响参加 PROTECTION 多中心临床试验的预定义亚组患者的死亡率，这些亚组包括1.对叹气的氧合生理反应（有反应者与无反应者）；2.设定的呼气末正压（PEEP）水平（高PEEP与低PEEP）。如果叹气和不叹气之间的死亡率存在差异，我们将在 7 天后探讨每天的生理差异：患者被随机分配到有叹息的压力支持通气（PSV）（叹息组）和无叹息的压力支持通气（PSV）（无叹息组）。(1）叹气与基线叹气测试应答者 28 天死亡率的差异无关。相反，在无应答者中，56 名患者被随机分配到叹气组（55%），叹气组的 28 天死亡率较低（17%vs.36%，log-rank p = 0.031）。(2）在 PEEP > 8cmH2O 的患者中，没有观察到叹气对死亡率的影响。在低 PEEP 条件下，54 名患者随机选择了叹气（48%）。随机采用叹气的患者 28 天的死亡率有所降低（13%vs.31%，log-rank p = 0.021）。这些研究结果经多变量调整后仍保持稳定。与不叹气相比，叹气可在 7 天内减少潮气量、呼吸频率和通气比。通气比与无应答者和低PEEP患者的死亡率和成功拔管有关：结论：在 PSV 中添加 Sigh 可降低对 Sigh 无反应和暴露于 Low-PEEP 的 AHRF 患者的死亡率。非应答者的结果出乎意料。低 PEEP 组的结果可能表明使用的 PEEP 不足，或低 PEEP 可与 Sigh 同时使用。Sigh 可通过减少生理死腔、通气强度和/或优化通气/灌注不匹配来降低死亡率：临床试验注册：ClinicalTrials.gov；标识符：NCT03201263：临床试验注册：ClinicalTrials.gov；标识符：NCT03201263。
Heterogeneous impact of Sighs on mortality in patients with acute hypoxemic respiratory failure: insights from the PROTECTION study.
Background: Sigh breaths may impact outcomes in acute hypoxemic respiratory failure (AHRF) during assisted mechanical ventilation. We investigated whether sigh breaths may impact mortality in predefined subgroups of patients enrolled in the PROTECTION multicenter clinical trial according to: 1.the physiological response in oxygenation to Sigh (responders versus non-responders) and 2.the set levels of positive end-expiratory pressure (PEEP) (High vs. Low-PEEP). If mortality differed between Sigh and No Sigh, we explored physiological daily differences at 7-days.
Results: Patients were randomized to pressure support ventilation (PSV) with Sigh (Sigh group) versus PSV with no sigh (No Sigh group). (1) Sighs were not associated with differences in 28-day mortality in responders to baseline sigh-test. Contrarily-in non-responders-56 patients were randomized to Sigh (55%) and 28-day mortality was lower with sighs (17%vs.36%, log-rank p = 0.031). (2) In patients with PEEP > 8cmH2O no difference in mortality was observed with sighs. With Low-PEEP, 54 patients were randomized to Sigh (48%). Mortality at 28-day was reduced in patients randomised to sighs (13%vs.31%, log-rank p = 0.021). These findings were robust to multivariable adjustments. Tidal volume, respiratory rate and ventilatory ratio decreased with Sigh as compared with No Sigh at 7-days. Ventilatory ratio was associated with mortality and successful extubation in both non-responders and Low-PEEP.
Conclusions: Addition of Sigh to PSV could reduce mortality in AHRF non-responder to Sigh and exposed to Low-PEEP. Results in non-responders were not expected. Findings in the low PEEP group may indicate that insufficient PEEP was used or that Low PEEP may be used with Sigh. Sigh may reduce mortality by decreasing physiologic dead space and ventilation intensity and/or optimizing ventilation/perfusion mismatch.
期刊介绍：
Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
