Thuật toán tuyển chọn bệnh nhân trong thử nghiệm PROMIZING để xác định sớm những bệnh nhân sẵn sàng cho việc thở tự nhiên

Critical Care - 2022
C. Brault1, Jordi Mancebo2, Juan-Carlos Suarez Montero2, Tracey Bentall3, Karen E. A. Burns3, Thomas Piraino4, François Lellouche5, Pierre-Alexandre Bouchard6, Emmanuel Charbonney7, Guillaume Carteaux8, Tommaso Maraffi9, G. Béduneau10, Alain Mercat11, Yoanna Skrobik12, Fei Zuo4, Myriam Lafrenière-Roula13, Kevin E. Thorpe14, Laurent Brochard3, Karen J. Bosma15
1Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, 209 Victoria St, Toronto, ON, Canada
2Intensive Care Department, Hospital Universitari de La Santa Creu I Sant Pau, Barcelona, Spain
3Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
4Unity Health Toronto - St. Michael’s Hospital, Toronto, ON, Canada
5Département de Médecine Québec, Université Laval, Québec City, QC, Canada
6Institut Universitaire de Cardiologie Et de Pneumologie de Québec, Québec City, QC, Canada
7Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
8Medical Intensive Care Department, AP-HP, Henri Mondor University Hospital, Créteil, France
9Service de Réanimation, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000, Créteil, France
10UNIROUEN, EA 3830, medical intensive care unit, Rouen university hospital, Normandie university, 76000 Rouen, France
11Medical Intensive Care Unit, Angers University Hospital, Angers, France
12Opus Clinic, Montreal, QC, Canada
13Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
14Dalla Lana School of Public Health, University of Toronto and Applied Health Research Centre, Toronto, ON, Canada
15London Health Sciences Centre, University of Western Ontario, London, ON, Canada

Tóm tắt

Tóm tắt Nền tảng Giải phóng bệnh nhân khỏi thở máy (MV) đòi hỏi một cách tiếp cận hệ thống. Trong khuôn khổ của một thử nghiệm lâm sàng, chúng tôi đã phát triển một thuật toán đơn giản để xác định những bệnh nhân chịu đựng được hỗ trợ thở nhưng vẫn cần tiếp tục thở máy để được phân nhóm ngẫu nhiên. Chúng tôi báo cáo về việc sử dụng thuật toán này để sàng lọc các ứng viên tiềm năng cho việc tham gia và phân nhóm ngẫu nhiên trong nghiên cứu Thông khí Giúp Tỷ lệ Để Giảm Thời gian Thở máy (PROMIZING). Phương pháp Thuật toán bao gồm năm bước: tiêu chí tham gia, thử nghiệm dung nạp thở hỗ trợ áp lực (PSV), tiêu chí cai thở, thử nghiệm dung nạp áp lực dương liên tục (CPAP) (0 cmH2O trong 2 phút) và thử nghiệm thở tự phát (SBT): với tỷ lệ oxy hít vào (FiO2) 40% trong 30–120 phút. Những bệnh nhân không đạt tiêu chí cai thở, thử nghiệm CPAP Zero hoặc SBT sẽ bị phân nhóm ngẫu nhiên. Chúng tôi mô tả các đặc điểm của những bệnh nhân đã được tuyển chọn ban đầu nhưng đã vượt qua tất cả các bước trong thuật toán và do đó không bị phân nhóm ngẫu nhiên.

Từ khóa

#Thở máy #giải phóng bệnh nhân #thử nghiệm lâm sàng #thuật toán tuyển chọn #hỗ trợ thở #cai thở.

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Critical Care

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