Effect Of Erector Spinae Plane Block At T8 Plane On Mechanical Ventilation Time In Patients With Acute Gastrointestinal Injury

BackgroundAcute gastrointestinal injury(AGI)refers to the gastrointestinal dysfunction caused by acute diseases in critically ill patients,which is not only an important part of multi-organ failure but also the initial link leading to enteric-borne sepsis.Up to 60%of patients in intensive care units(ICU)may develop AGI,and approximately 40%to 50%of ICU patients need mechanical ventilation support.Studies showed that AGI,mechanical ventilation,and sepsis can be causes of each other,and the vicious cycle among the three can lead to poor prognosis of patients.AGI treatment as a breakthrough may be the key to solving this problem,but the conventional treatment effect of AGI is not optimistic.Developed in 2016,erector spinus plane nerve block(ESPB)is a regional nerve block technique with easy operation,high safety,and few complications.ESPB has been shown to reduce AGI severity and improve gastrointestinal function in preliminary clinical studies.To evaluate whether the treatment of AGI with ESPB can reduce mechanical ventilation time and improve ventilator weaning,AGI patients with mechanical ventilation were selected as research objects to conduct a retrospective analysis of their therapeutic effects and explore the related factors affecting the ventilator weaning of AGI patients with severe AGI.Objective1.For patients with severe AGI,evaluate whether ESPB treatment can reduce mechanical ventilation time and improve ventilator weaning.2.To explore the related factors affecting the ventilator weaning of severe AGI patients.3.Evaluate whether ESPB therapy can reduce the dose of opioid analgesics in AGI patients.4.To evaluate whether ESPB treatment can improve the survival prognosis of severe AGI patients.MethodsThis study was a post-hoc analysis based on data from a previous prospective randomized controlled clinical study(RCT).AGI mechanical ventilation cases in this RCT were collected according to criteria and divided into ESPB combined conventional treatment(ESPB group)and conventional treatment(Non-ESPB group)according to treatment methods.Baseline data,treatment parameters,and outcomes of the two groups were recorded and compared.Mechanical ventilation duration,ventilator weaning condition,opioid analgesic drug dosage,and survival prognosis of the two groups were analyzed.The factors that may affect ventilator weaning(gender,age,AGI treatment,combined with acute kidney injury,vasoactive drug use,fluid balance,analgesic drug dose,history of central nervous system disease,artificial airway type,APACHE II score)were evaluated.The stepwise regression method and Cox proportional risk model were used to analyze the above factors.ResultsA total of 82 AGI patients with mechanical ventilation were screened,including 66 patients meeting the inclusion and exclusion criteria,of which 33 patients were in the ESPB group and 33 patients were in the Non-ESPB group.In terms of mechanical ventilation duration,there was no difference between groups in either mechanical ventilation duration or total mechanical ventilation duration after treatment.However,the number of ventilator-free days at day 28 was significantly higher in the ESPB group than in the Non-ESPB group(21.0(IQR,0.0-24.0)vs 0.0(IQR,0.0-18.0),P=0.025).A total of 35 patients were successfully taken offline in ICU,and the number of cases in the ESPB group was significantly higher than that in the Non-ESPB group(22 vs 13,P=0.026).In the Cox model,the univariate analysis found that there were 5 variables associated with ventilator weaning.The stepwise regression method was continued to conduct multivariate analysis on the 5 variables,and it was found that combined acute kidney injury,vasoactive drug use,and positive fluid balance were independent risk factors affecting the weaning failure of AGI patients(P<0.05).In terms of analgesic use,the daily dose of opioid analgesics was reduced in the ESPB group(200(IQR,155325)mg vs.291(IQR,207-438)mg,P=0.025).The 30-day mortality rate(27.3%vs 51.5%,P=0.044),the number of ICU survivors(21 vs 11,P=0.014),and the number of ICU deaths(1 vs 8,P=0.027)were statistically different between the ESPB and NonESPB groups.ConclusionIn severely ill AGI patients,ESPB increased ventilator-free time for 28 days.In addition,ESPB treatment was associated with reduced opioid analgesic dose,and improved ventilator weaning and survival outcomes.Acute kidney injury,vasoactive drug use,and positive fluid balance were independent risk factors for ventilator weaning failure.