微量吸入与呼吸机相关事件之间的关系:随机对照试验的事后分析。

Guillaume Millot, Hélène Behal, Emmanuelle Jaillette, Christophe Girault, Guillaume Brunin, Julien Labreuche, Isabelle Alves, Franck Minacori, Hugues Georges, Patrick Herbecq, Cyril Fayolle, Patrice Maboudou, Farid Zerimech, Malika Balduyck, Saad Nseir
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引用次数: 0

摘要

目的:尚未研究插管患者呼吸机相关事件(VAE)与微量吸入之间的关系。本研究旨在评估大量口咽分泌物或胃内容物微吸入与 VAE 发生率之间的关系:这项研究是对 BESTCUFF 研究的一项事后分析,BESTCUFF 研究是一项多中心、分组随机、交叉对照、开放标签试验,对象是通气时间超过 48 小时的成年患者。根据美国国家医疗安全网的标准,根据 PEEP 或 FiO2 与前几天稳定参数相比的变化来确定 VAE。结果:共纳入 261 例患者,其中 31 例(11.9%)出现 VAE,总中位数年龄为 65 岁(四分位间范围为 52-74),男性患者占多数(164 例,62.8%),SAPS II 中位数年龄为 65 岁(四分位间范围为 52-74),男性患者占多数(164 例,62.8%),SAPS II 中位数年龄为 65 岁(四分位间范围为 52-74),男性患者占多数(164 例,62.8%),SAPS II 中位数年龄为 65 岁(四分位间范围为 52-74),男性患者占多数(164 例,62.8%)。VAE的发生率与丰富的全身微量吸入无显著相关性(调整后的病因特异性危险比(cHR):1.VAE的发生率与大量胃微吸气(调整后病因特异性危险比(cHR):1.55 [0.46-5.17])、大量胃微吸气(调整后cHR:1.24 [0.61-2.53])或大量口咽微吸气(调整后HR:1.07 [0.47-2.42])无显著相关性:结论:我们的研究结果表明,大量全胃、胃或口咽微吸气与 VAE 的发生率无明显关系:本研究强调,测量插管重症患者的微吸入量可能无法用于预测 VAE 的诊断或评估旨在预防这些并发症的干预措施。
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Relationship between microaspiration and ventilator-associated events: A post-hoc analysis of a randomized controlled trial.

Objective: The relationship between ventilator-associated events (VAE) and microaspiration in intubated patients has not be studied. The objective of this study was to evaluate the relationship between abundant microaspiration of oropharyngeal secretions or gastric contents and the incidence of VAE.

Patients and methods: This was a post hoc analysis of the BESTCUFF study, which was a multicenter, cluster randomized, cross-over, controlled, open-label trial in adult patients ventilated for over 48 h. All tracheal aspirates were sampled for 48 h following enrollment, with quantitative measurement of pepsin and alpha-amylase. VAE were identified using National Healthcare Safety Network criteria, based on PEEP or FiO2 variations compared to stable parameters in previous days. The primary objective was to assess the relationship between abundant global microaspiration and the incidence of VAE, adjusted for pre-specified confounding factors (sex, SAPS II score and Glasgow coma scale).

Results: 261 patients were included, of which 31 (11.9%) developed VAE, with an overall median age of 65 (interquartile range 52-74), a majority of male patients (164, 62.8%), a median SAPS II score of 50 [40-61], a median SOFA score of 8 [5-11], and acute respiratory failure as main reason for ICU admission (117, 44.8%).The incidence of VAE was not significantly associated with abundant global microaspiration (adjusted cause-specific hazard ratio (cHR): 1.55 [0.46-5.17), abundant gastric microaspiration (adjusted cHR: 1.24 [0.61-2.53), or with abundant oropharyngeal microaspiration (adjusted HR: 1.07 [0.47-2.42]).

Conclusions: Our results suggest no significant association between abundant global, gastric or oropharyngeal microaspiration and the incidence of VAE.

Implications for clinical practice: This study underscores that measuring microaspiration in intubated critically ill patients might not be useful to predict the diagnosis of VAE or to evaluate interventions aiming at preventing these complications.

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