中国多省份重症医学科ARDS患者机械通气的横断面调查

A cross-sectional survey of mechanical ventilation in ICU patients with ARDS in multiple provinces in China

目的通过评估国内多省份重症医学科(ICU)患者机械通气相关治疗方面的差异性,以提高ICU患者机械通气相关治疗的实践与管理质量。方法2022年9月29日以问卷调查的方式开展急性呼吸窘迫综合征(ARDS)患者机械通气的横断面调查。结果总收纳患者中ARDS占11.74%,主要为男性患者。在ARDS的病因中,肺内因素以原发性肺炎为主,而肺外因素主要涉及消化系统(如肠穿孔、肠梗阻)和神经系统疾病(如脑卒中)。收集到的患者中,非吸入性肺炎是ARDS的主要来源(占79.17%),其次是肺内感染(占76.92%),肠道感染也是一个较常见的来源。在诊断ARDS的诊断方面,急性生理性与慢性健康评分(APACHEⅡ)提示病情危重和中重度患者比例分别为75.00%和47.92%。重症肺部超声在ARDS患者中的应用较为普遍,约占收纳病例的56.25%,而膈肌超声的实践率较低,仅有18.75%,且均发生在三甲医院内。声门下吸引的总体实施率为45.71%,实施组中肺内组和肺外组无明显差异。气囊压监测的实施率为62.86%,东部地区的三甲医院实施率最高。在ARDS治疗方面,通气模式以压力控制通气为主(62.86%),高流量湿化氧疗占据76.92%,普通湿化氧疗占据23.08%。小潮气量的实施率为68.57%,东部地区的三甲医院(肺内组)和中部地区的三甲医院(肺外组)实施率较高。高呼吸频率、高呼气末正压(PEEP)、高碳酸血症的治疗实施率较低,可能与疾病的病程和基础疾病相关。镇静镇痛的实施率为62.86%。结论ARDS的诊断和治疗需要综合考虑患者的病情和临床表现。在治疗中,通气模式、湿化氧疗、小潮气量等的实施率都比较高,但高呼吸频率、PEEP、高碳酸血症的治疗实施率较低,需要加强。此外,应该加强ARDS的预防和早期干预,以降低其发生率和病死率。

Objective To improve the practice and management quality of mechanical ventilation-related treatments for ICU patients by evaluating the differences in mechanical ventilation-related treatments among ICU patients in multiple provinces in China.Methods On September 29,2022,a cross-sectional survey of mechanical ventilation in patients with acute respiratory distress syndrome(ARDS)was conducted through questionnaires.Results ARDS accounted for 11.7%of the total cases,mainly male patients.In the etiologies of ARDS,primary pneumonia was the main intrapulmonary factor,while extrapulmonary factors mainly involved the digestive system(such as intestinal perforation and obstruction)and neurological diseases(such as stroke).Among the collected cases,non-aspiration pneumonia was the main source of ARDS(79.17%),followed by pulmonary infections(76.92%),and intestinal infection was also a more common source.In the diagnosis of ARDS,the Acute Physiology and Chronic Health Evaluation(APACHEⅡ)indicated that the proportions of critically ill and moderate to severe patients were 75.00%and 47.92%,respectively.The application of lung ultrasound in severe ARDS patients was relatively common,accounting for 56.25%of the admitted cases,while the practice rate of diaphragmatic ultrasound was low,only 18.75%,and all occurred in GradeⅢLevel A hospitals.The overall implementation rate of subglottic secretion suction was 45.71%,and there was no significant difference between the intrapulmonary and extrapulmonary groups in the implementation groups.The implementation rate of airbag pressure monitoring was 62.86%,with the highest implementation rate in GradeⅢLevel A hospitals in the eastern region.In terms of ARDS treatment,the ventilation mode was mainly pressure-controlled ventilation(62.86%),with humidified high-flow oxygen therapy accounting for 76.92%and ordinary humidified oxygen therapy accounting for 23.08%.The implementation rate of low tidal volume ventilation was 68.57%,with higher implementation rates in GradeⅢLevel A hospitals(the intrapulmonary group)in the eastern region and GradeⅢLevel A hospitals(the extrapulmonary group)in the central region.The implementation rates of treatment for high respiratory rate,high positive end-expiratory pressure(PEEP),and hypercapnia were relatively low,which may be related to the course and underlying disease of the disease.The implementation rate of sedation and analgesia was 62.86%.Conclusion The diagnosis and treatment of ARDS require comprehensive consideration of the patient’s condition and clinical manifestations.In treatment,the implementation rates of ventilation mode,humidified oxygen therapy,low tidal volume,etc.were relatively high,but the implementation rates of treatment for high respiratory rate,PEEP,and hypercapnia were low and needed to be strengthened.In addition,the prevention and early intervention of ARDS should be strengthened to reduce its incidence and mortality rate.