Herce A, Lerga C, Martínez A, Zapata M A, Asiain M C
Unidad de Cuidados Intensivos, Clínica Universitaria de Navarra, Pamplona.
Enferm Intensiva. 1999 Jul-Sep;10(3):99-109.
Endotracheal aspiration protocols (EAT) include hyperoxygenation and hyperinflation to minimize the negative effects of the technique. No conclusive studies have determined the most effective hyperoxygenation and hyperinflation method. This study had two aims: to compare the effects on patient oxygenation and hemodynamics during endotracheal aspiration of secretions using, respectively, a respirator or manual resuscitator as the hyperoxygenation and hyperinflation method. Tidal volume (TV) and FIO2 with the manual resuscitator were quantified. The study was based on 172 aspiration sessions carried out under artificial ventilation in the immediate postoperative period of 26 patients who had undergone cardiac surgery without lung damage. Hyperinflation and hyperoxygenation before, during and after aspiration were carried out with and artificial ventilator in group I and with a manual resuscitator in group II. In all aspiration interventions, an analysis was made of hemodynamic parameters (MAP, MPAP, HR, CO and arrhythmias), ventilation and oxygenation parameters (HR, FIO2, SpO2, and SvO2), and the influence of the method on the appearance of atelectasis. Both methods produced small increases in all hemodynamic parameters, and significant differences in HR (p < 0.001) and MPAP (p < 0.002), although no clinical repercussions were observed. No severe arrhythmias were observed. No statistically significant differences between the two methods were found in the evolution of SpO2 and SvO2, which remained above baseline levels throughout both procedures. Analysis of the effectiveness of the manual resuscitator (the second aim) under the conditions established yielded a mean FIO2 of 0.86 and a mean tidal volume of 153% in relation to baseline tidal volume. Both methods of hyperoxygenation and hyperinflation prevent hypoxia and maintain hemodynamic stability in patients without producing lung damage. The effectiveness of the manual resuscitator for administering high oxygen concentration and large volumes was confirmed.
气管内吸引方案（EAT）包括高氧通气和肺过度充气，以尽量减少该技术的负面影响。尚无确凿研究确定最有效的高氧通气和肺过度充气方法。本研究有两个目的：分别比较使用呼吸机或手动复苏器作为高氧通气和肺过度充气方法时，气管内吸引分泌物对患者氧合和血流动力学的影响。对使用手动复苏器时的潮气量（TV）和吸入氧分数（FIO₂）进行了量化。该研究基于26例接受心脏手术且无肺损伤患者术后即刻在人工通气下进行的172次吸引操作。第一组在吸引前、吸引期间和吸引后使用人工呼吸机进行肺过度充气和高氧通气，第二组使用手动复苏器。在所有吸引干预中，分析了血流动力学参数（平均动脉压、平均肺动脉压、心率、心输出量和心律失常）、通气和氧合参数（心率、FIO₂、脉搏血氧饱和度和混合静脉血氧饱和度），以及该方法对肺不张出现的影响。两种方法均使所有血流动力学参数略有增加，心率（p<0.001）和平均肺动脉压（p<0.002）有显著差异，尽管未观察到临床影响。未观察到严重心律失常。两种方法在脉搏血氧饱和度和混合静脉血氧饱和度的变化方面未发现统计学显著差异，在整个过程中均保持高于基线水平。在既定条件下对手动复苏器的有效性（第二个目的）进行分析，结果显示相对于基线潮气量，平均FIO₂为0.86，平均潮气量为153%。两种高氧通气和肺过度充气方法均可防止患者缺氧并维持血流动力学稳定，且不会造成肺损伤。证实了手动复苏器在给予高氧浓度和大容量气体方面的有效性。
