机构地区：[1]Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China [2]Department of Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China [3]Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China [4]Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China [5]Neurological Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China [6]Department of Critical Care Medicine, Guangdong General Hospital, Guangzhou, Guangdong 510000, China [7]Surgical Intensive Care Unit, Fujian Province Hospital, Fuzhou, Fujian 350000, China [8]Department of Critical Care Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China [9]Department of Critical Care Medicine, Bethune International Peace Hospital, Shijiazhuang, Hebei 050000, China [10]Department of Critical Care Medicine, Yuncheng Central Hospital, Yuncheng, Shanxi 044000, China [11]Department of Emergency and Critical Care Medicine, Cangzhou People's Hospital, Cangzhou, Hebei 061000, China [12]Department of Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China [13]Department of Critical Care Medicine, First Hospital of China Medical University, Shenyang, Liaoning 110000, China [14]Department of Critical Care Medicine, Shanghai Changzheng Hospital, Shanghai 200000, China [15]Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China [16]Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China [17]Department of Critical Care Medicine, Miyun County Hospital, Beijing 100038, China [18]Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing 101500, China [19]Department of Critical Care Medicine, Beijing Fr
出 处：《Chinese Medical Journal》2016年第14期1643-1651,共9页中华医学杂志（英文版）
摘 要：Background： Over the years, the mechanical ventilation （MV） strategy has changed worldwide. The aim of the present study was to describe the ventilation practices, particularly lung-protective ventilation （LPV）, among brain-injured patients in China. Methods： This study was a multicenter, 1-day, cross-sectional study in 47 Intensive Care Units （ICUs） across China. Mechanically ventilated patients （18 years and older） with brain injury in a participating ICU during the time of the study, including traumatic brain injury, stroke, postoperation with intracranial tumor, hypoxic-ischemic encephalopathy, intracranial infection, and idiopathic epilepsy, were enrolled. Demographic data, primary diagnoses, indications for MV, MV modes and settings, and prognoses on the 60th day were collected. Multivariable logistic analysis was used to assess factors that might affect the use of LPV. Results： A total of 104 patients were enrolled in the present study, 87 （83.7%） of whom were identified with severe brain injury based on a Glasgow Coma Scale 〈8 points. Synchronized intermittent mandatory ventilation （SIMV） was the most frequent ventilator mode, accounting for 46.2% of the entire cohort. The median tidal volume was set to 8.0 ml/kg （interquartile range [IQR], 7.0-8.9 ml/kg） of the predicted body weight; 50 （48.1%） patients received LPV. The median positive end-expiratory pressure （PEEP） was set to 5 cmH20 （IQR, 5-5 cmH20）. No PEEP values were higher than 10 cmH20. Compared with partially mandatory ventilation, supportive and spontaneous ventilation practices were associated with LPV. There were no significant differences in mortality and MV duration between patients subjected to LPV and those were not. Conclusions： Among brain-injured patients in China, SIMV was the most frequent ventilation mode. Nearly one-half of the brain-injured patients received LPV. Patients under supportive and spontaneous ventilation were more likely to receive LPV.Background： Over the years, the mechanical ventilation （MV） strategy has changed worldwide. The aim of the present study was to describe the ventilation practices, particularly lung-protective ventilation （LPV）, among brain-injured patients in China. Methods： This study was a multicenter, 1-day, cross-sectional study in 47 Intensive Care Units （ICUs） across China. Mechanically ventilated patients （18 years and older） with brain injury in a participating ICU during the time of the study, including traumatic brain injury, stroke, postoperation with intracranial tumor, hypoxic-ischemic encephalopathy, intracranial infection, and idiopathic epilepsy, were enrolled. Demographic data, primary diagnoses, indications for MV, MV modes and settings, and prognoses on the 60th day were collected. Multivariable logistic analysis was used to assess factors that might affect the use of LPV. Results： A total of 104 patients were enrolled in the present study, 87 （83.7%） of whom were identified with severe brain injury based on a Glasgow Coma Scale 〈8 points. Synchronized intermittent mandatory ventilation （SIMV） was the most frequent ventilator mode, accounting for 46.2% of the entire cohort. The median tidal volume was set to 8.0 ml/kg （interquartile range [IQR], 7.0-8.9 ml/kg） of the predicted body weight; 50 （48.1%） patients received LPV. The median positive end-expiratory pressure （PEEP） was set to 5 cmH20 （IQR, 5-5 cmH20）. No PEEP values were higher than 10 cmH20. Compared with partially mandatory ventilation, supportive and spontaneous ventilation practices were associated with LPV. There were no significant differences in mortality and MV duration between patients subjected to LPV and those were not. Conclusions： Among brain-injured patients in China, SIMV was the most frequent ventilation mode. Nearly one-half of the brain-injured patients received LPV. Patients under supportive and spontaneous ventilation were more likely to receive LPV.
关 键 词：Brain Injury EPIDEMIOLOGY Lung-protective Ventilation Mechanical Ventilation
分 类 号：TH778[机械工程—仪器科学与技术] F407.7[机械工程—精密仪器及机械]
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