Objective To explore the impact and potential role of the 4P strategy of circulatory protection on the prognosis and outcome of mechanically ventilated patients with ARDS. Methods Thirty-seven ARDS patients admitted to the department of critical care medicine of Peking Union Medical College Hospital,Chinese Academy of Medical Sciences from March 2021 to June 2022 who were mechanically ventilated and adhered to the 4P strategy of circulatory protection ventilation were retrospectively included,and 37 patients in the non-4P group were paired 1:1 according to age,sex. The 4P strategy consisted of CVP<10 mmHg,PI>0.6,Pmean ≤10 cmH2O,and PPV ≤12％. The primary outcomes were ICU mortality,hours in the ICU,duration of mechanical ventilation,and days off mechanical ventilation at 28 days. Non-parametric paired-sample tests were used to compare differences in baseline data and outcome indicators between the two groups,and the Kapan-Meier method was used to analyse the cumulative risk of in-hospital ICU mortality and 28-day unused mechanical ventilation time. Results There were no deaths in patients in the 4P group and the mortality rate was 2.70％ (1 case) in the non-4P group,and there was no statistically significant difference in deaths between the two groups (P>0.05). The hours of ICU care in patients in the 4P group[150.00 (123.50,203.00) h vs. 205. 00 (148.50,306.50) h,P=0.017],the hours of mechanical ventilation[84.00 (57.50,121.00) h vs. 105.00 (74.50,170.50) h,0.004]were shorter in the 4P group than in the non-4P group,the differences were statistically significant (P<0.05). The number of days without mechanical ventilation at 28-day was longer in the 4P group than in the non-4P group[24.50 (22.96,25.60) d vs. 23.63 (20.90,24.90) d],the difference was statistically significant (P=0.004). The cumulative fraction curve showed a significant increase in the days without mechanical ventilation at 28-day in patients in the 4P group at the end of monitoring,the difference was statistically significant (P=0.018). There was no significant difference in the survival analysis curves between the two groups (P=0.433). Conclusion The 4P strategy of circulatory protection ventilation reduces the duration of mechanical ventilation in critically ill patients and improves the prognosis of patients with ARDS. Relevant results need to be confirmed in multi-center clinical studies.
关键词
急性呼吸窘迫综合征/循环保护通气4P标准策略/机械通气时间/ICU监护时间/死亡率/预后
Key words
acute respiratory distress syndrome/4P strategy of circulatory protection ventilation/duration of mechanical ventilation/ICU monitoring time/mortality/prognosis
维普
万方数据