Pressure control plus spontaneous ventilation versus volume assist-control ventilation in acute respiratory distress syndrome. A randomised clinical trial.
| Autor: | Richard JM; Médecine Intensive, Réanimation, Vent'Lab, CHU d'Angers, University Hospital of Angers, Angers, France. Jcmb.richard@gmail.com.; Med2Lab, ALMS, Antony, France. Jcmb.richard@gmail.com., Beloncle FM; Médecine Intensive, Réanimation, Vent'Lab, CHU d'Angers, University Hospital of Angers, Angers, France., Béduneau G; Médecine Intensive, Réanimation, Univ Rouen Normandie, GRHVN UR 3830, CHU Rouen, Rouen, France., Mortaza S; Médecine Intensive, Réanimation, Vent'Lab, CHU d'Angers, University Hospital of Angers, Angers, France.; Réanimation Polyvalente, CH René Dubos, Pontoise, France., Ehrmann S; Médecine Intensive, Réanimation, INSERM CIC 1415, Crics-Triggersep F-CRIN Research Network, CHRU de Tours and Centre d'Etude des Pathologies Respiratoires, INSERM U1100, Université de Tours, Tours, France., Diehl JL; Médecine Intensive, Réanimation, Hôpital Européen Georges Pompidou, APHP, Paris, France., Prat G; Médecine Intensive, Réanimation, CHU de Brest, Brest, France., Jaber S; Réanimation Chirurgicale, CHU de Montpellier, Montpellier, France., Rahmani H; Médecine Intensive, Réanimation, CHU de Strasbourg NHC, Strasbourg, France., Reignier J; Médecine Intensive, Réanimation, Movement-Interactions-Performance, MIP UR 4334-CHU de Nantes, Nantes, France., Boulain T; Médecine Intensive, Réanimation, CHU d'Orléans, Orléans, France., Yonis H; Médecine Intensive, Réanimation, HC de Lyon, Lyon, France., Richecoeur J; Réanimation Polyvalente, CH de Beauvais, Beauvais, France., Thille AW; Médecine Intensive, Réanimation, CHU de Poitiers, Poitiers, France., Declercq PL; Médecine Intensive, Réanimation, CH Dieppe, Dieppe, France., Antok E; Réanimation Polyvalente, CHU Sud Réunion, La Réunion, France., Carteaux G; Médecine Intensive, Réanimation, Hôpital Henri Mondor, APHP, Créteil, France., Vielle B; Département de Biostatistiques, CHU d'Angers, Angers, France., Brochard L; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada., Mercat A; Médecine Intensive, Réanimation, Vent'Lab, CHU d'Angers, University Hospital of Angers, Angers, France. |
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| Jazyk: | angličtina |
| Zdroj: | Intensive care medicine [Intensive Care Med] 2024 Oct; Vol. 50 (10), pp. 1647-1656. Date of Electronic Publication: 2024 Sep 17. |
| DOI: | 10.1007/s00134-024-07612-3 |
| Abstrakt: | Purpose: The aim of this study was to compare the effect of a pressure-controlled strategy allowing non-synchronised unassisted spontaneous ventilation (PC-SV) to a conventional volume assist-control strategy (ACV) on the outcome of patients with acute respiratory distress syndrome (ARDS). Methods: Open-label randomised clinical trial in 22 intensive care units (ICU) in France. Seven hundred adults with moderate or severe ARDS (PaO Results: Hospital mortality [34.6% vs 33.5%, p = 0.77, risk ratio (RR) = 1.03 (95% confidence interval [CI] 0.84-1.27)], 28-day mortality, as well as the number of ventilator-free days and organ failure-free days at day 28 did not differ between PC-SV and ACV groups. Patients in the PC-SV group received significantly less sedation and neuro-muscular blocking agents than in the ACV group. A lower proportion of patients required adjunctive therapy of hypoxemia (including prone positioning) in the PC-SV group than in the ACV group [33.1% vs 41.3%, p = 0.03, RR = 0.80 (95% CI 0.66-0.98)]. The incidences of pneumothorax and refractory hypoxemia did not differ between the groups. Conclusions: A strategy based on PC-SV mode that favours spontaneous ventilation reduced the need for sedation and adjunctive therapies of hypoxemia but did not significantly reduce mortality compared to ACV with similar tidal volume and PEEP levels. (© 2024. The Author(s).) |
| Databáze: | MEDLINE |
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