S. De Vuono, Sokol Berisha, L. Settimi, P. Cianci, Alessandra Lignani, Gianmarco Lanci, M. Taliani, P. Groff
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引用次数: 0
摘要
背景:SARS-CoV-2相关肺炎的特征是中度至重度低氧血症,常伴有低碳酸血症,其预后作用文献很少。目的:评估低碳酸血症是否可以预测在这种情况下对无创机械通气(NIMV)的需求。材料与方法:前瞻性研究52例中重度SARS-CoV-2相关性肺炎患者。以下所有资料均于急诊科入院时收集,并经单因素和多因素分析处理:临床和实验室资料、室内空气血气分析和肺部超声。结果:33/52例(63.3%)接受了NIMV。在单变量分析中,PaCO2与NIMV需求呈负相关(OR 0.82, CI 95% 0,689-0,976, p .025)。在多变量分析中,PaCO2预测NIMV的需要独立于年龄、性别、合共病数量、d-二聚体、CRP、PaO2和LUS SCORE (OR 0.838, CI 95% 0,710-0,988, p .035)。结论:我们的数据表明,低碳酸血症可能是这些患者临床恶化的早期预测因素,独立于其他已知的不良预后预测因素,反映了深度和频繁呼吸模式的发生,可能与过度的跨肺压波动的产生相关,导致自我诱导的肺损伤(P-SILI)。需要进一步的研究来验证这些数据是否适用于更多的人群。
Hypocapnia as a predictor of the need for non-invasive mechanical ventilation in subjects with SARS-CoV-2 related pneumonia
Background: SARS-CoV-2 related pneumonia is characterized by moderate-to severe hypoxemia often associated with hypocapnia the prognostic role of which is poorely documented.
Aims: evaluate if hypocapnia can predict the need for non-invasive mechanical ventilation (NIMV) in this setting.
Materials and methods: we prospectively studied 52 subjects with moderate-severe SARS-CoV-2 related pneumonia. All the following data were collected at admission to the Emergency Department and processed by univariate and multivariate analysis: clinical and laboratory data, blood gas analysis in room air and lung ultrasound.
Results: 33/52 subjects (63,4%) underwent NIMV. At univariate analysis PaCO2 was inversely associated to the need for NIMV (OR 0,82, CI 95% 0,689-0,976, p .025). At multivariate analysis PaCO2 predicted the need for NIMV independently from age, gender, number of comorbidities, d-dimer, CRP, PaO2 and LUS SCORE (OR 0,838, CI 95% 0,710-0,988, p .035).
Conclusions: our data suggest that hypocapnia could be an early predictor of clinical worsening in these patients independently from other known predictors of unfavourable outcome, reflecting the occurrence of a deep and frequent respiratory pattern possibly related to the generation of excessive transpulmonary pressure swings leading to a self-induced lung injury (P-SILI). Further studies are needed for validating these data on greater populations.