现在的位置: 首页时讯速递, 进展交流>正文
[Intensive Care Med在线发表]:NAVA用于急性呼吸功能衰竭:一项随机对照试验
2020年10月14日 时讯速递, 进展交流 暂无评论

Original | Published: 

Neurally adjusted ventilatory assist in acute respiratory failure: a randomized controlled trial

Robert M. Kacmarek, Jesús Villar, Dácil Parrilla, et al

Intensive Care Med 2020

Abstract

Purpose 背景

We hypothesized that neurally adjusted ventilatory assist (NAVA) compared to conventional lung-protective mechanical ventilation (MV) decreases duration of MV and mortality in patients with acute respiratory failure (ARF).

我们假设神经调节通气支持(NAVA)与传统肺保护机械通气(MV)相比,能够缩短急性呼吸功能衰竭(ARF)患者MV时间,降低病死率。

Methods 方法

We carried out a multicenter, randomized, controlled trial in patients with ARF from several etiologies. Intubated patients ventilated for ≤ 5 days expected to require MV for ≥ 72 h and able to breathe spontaneously were eligible for enrollment. Eligible patients were randomly assigned based on balanced treatment assignments with a computerized randomization allocation sequence to two ventilatory strategies: (1) lung-protective MV (control group), and (2) lung-protective MV with NAVA (NAVA group). Allocation concealment was maintained at all sites during the trial. Primary outcome was the number of ventilator-free days (VFDs) at 28 days. Secondary outcome was all-cause hospital mortality. All analyses were done according to the intention-to-treat principle.

我们针对多种病因引起的ARF患者进行了一项多中心、随机、对照试验。机械通气≤ 5天、预计需要MV ≥ 72 h且能自主呼吸的患者入选。根据平衡治疗分组原则,采用计算机随机分配次序,入选患者接受随机分组:(1)肺保护MV(对照组)和(2)肺保护MV与NAVA(NAVA组)。试验期间在所有中心保持分配隐藏。主要预后终点为28天内无机械通气天数(VFDs)。次要预后终点为全因病死率。所有分析均遵循意向治疗原则。

Results 结果

Between March 2014 and October 2019, we enrolled 306 patients and randomly assigned 153 patients to the NAVA group and 153 to the control group. Median VFDs were higher in the NAVA than in the control group (22 vs. 18 days; between-group difference 4 days; 95% confidence interval [CI] 0 to 8 days; p = 0.016). At hospital discharge, 39 (25.5%) patients in the NAVA group and 47 (30.7%) patients in the control group had died (between-group difference − 5.2%, 95% CI − 15.2 to 4.8, p = 0.31). Other clinical, physiological or safety outcomes did not differ significantly between the trial groups.

2014年3月至2019年10月间,我们共入选306名患者,其中153名患者随机分至NAVA组,153名患者随机分至对照组。与对照组相比,NAVA组VFDs中位数更高(22 vs. 18 天; 组间差异 4 天; 95% 可信区间 [CI] 0 to 8 天; p = 0.016)。出院时,NAVA组39名 (25.5%) 患者及对照组47名 (30.7%) 患者死亡 (组间差异 − 5.2%, 95% CI − 15.2 to 4.8, p = 0.31)。两组间其他临床、生理或安全终点无显著差异。

Conclusion 结论

NAVA decreased duration of MV although it did not improve survival in ventilated patients with ARF.

NAVA缩短ARF患者MV时间,尽管并不改善生存率。

给我留言

您必须 [ 登录 ] 才能发表留言!

×
腾讯微博