CC:脓毒症患者有创机械通气时机的影响:一项多中心队列研究

Abstract

Background：The potential adverse effects associated with invasive mechanical ventilation (MV) can lead to delayed decisions on starting MV. We aimed to explore the association between the timing of MV and the clinical outcomes in patients with sepsis ventilated in intensive care unit (ICU).侵入性机械通气（MV）可能带来的不良反应可能导致延迟决定开始MV。我们旨在探讨MV时机与在重症监护病房（ICU）接受通气的脓毒症患者的临床结果之间的关联。

Methods：We analyzed data of adult patients with sepsis between September 2019 and December 2021. Data was collected through the Korean Sepsis Alliance from 20 hospitals in Korea. Patients who were admitted to ICU and received MV were included in the study. Patients were divided into ‘early MV’ and ‘delayed MV’ groups based on whether they were on MV on the first day of ICU admission or later. Propensity score matching was applied, and patients in the two groups were compared on a 1:1 ratio to overcome bias between the groups. Outcomes including ICU mortality, hospital mortality, length of hospital and ICU stay, and organ failure at ICU discharge were compared.我们分析了2019年9月至2021年12月期间成年脓毒症患者的数据。数据通过韩国脓毒症联盟从韩国20家医院收集。纳入研究的是入住ICU并接受MV的患者。根据是否在ICU入院第一天就接受MV，将患者分为“早期MV”和“延迟MV”两组。应用倾向得分匹配，以1:1的比例比较两组患者，以克服组间的偏差。比较了包括ICU死亡率、医院死亡率、住院和ICU住院时间以及ICU出院时器官衰竭在内的结果。

Results：Out of 2440 patients on MV during ICU stay, 2119 ‘early MV’ and 321 ‘delayed MV’ cases were analyzed. The propensity score matching identified 295 patients in each group with similar baseline characteristics. ICU mortal‐ ity was lower in ‘early MV’ group than ‘delayed MV’ group (36.3% vs. 46.4%; odds ratio, 0.66; 95% confidence interval, 0.47–0.93; p = 0.015). ‘Early MV’ group had lower in‐hospital mortality, shorter ICU stay, and required tracheostomy less frequently than ‘delayed MV’ group. Multivariable logistic regression model identified ‘early MV’ as associated with lower ICU mortality (odds ratio, 0.38; 95% confidence interval, 0.29–0.50; p < 0.001).在ICU住院期间接受MV的2440名患者中，分析了2119例“早期MV”和321例“延迟MV”。倾向得分匹配确定了每组295名具有相似基线特征的患者。与“延迟MV”组相比，“早期MV”组的ICU死亡率较低（36.3% vs. 46.4%；比值比，0.66；95%置信区间，0.47–0.93；p = 0.015）。“早期MV”组的院内死亡率较低，ICU住院时间较短，且较少需要气管切开。多变量逻辑回归模型确定“早期MV”与较低的ICU死亡率相关（比值比，0.38；95%置信区间，0.29–0.50；p < 0.001）。

Conclusion：In patients with sepsis ventilated in ICU, earlier start (first day of ICU admission) of MV may be associated with lower mortality.在ICU接受通气的脓毒症患者中，更早开始（ICU入院第一天）的MV可能与较低的死亡率相关。

和我写的一模一样的感觉，就少我一个accept了。老天保佑我啊