Knothe C, Huber T, Hiltl P, Regel G, Bayeff-Filloff M
Institut für Anästhesiologie und operative Intensivmedizin, Klinikum Rosenheim.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2000 May;35(5):306-15. doi: 10.1055/s-2000-326.
The ventilation mode clearly influences the course of patients with multiple trauma on the ICU. Ventilation according the "open lung" approach rapidly opens up atelectatic lung regions. Generation of an adequate intrinsic PEEP enables to keep the lung open. We studied the consequences of the "open lung" approach on the lung function and monitored its side effects on patients with multiple trauma.
18 consecutive patients with multiple trauma and additional thoracic trauma were routinely ventilated according the "open lung" approach between May and November 1999. We were mainly interested in data of lung mechanics, oxygenation and ventilation. Side effects on other organ systems and consequence for the infection rate were monitored.
Ventilation according the "open lung" approach enables early sufficient oxygenation and ventilation of patients with severe multiple trauma and accompanying thoracic trauma. The ventilation mode helps to prevent baro-, volu- and atelectrauma and thus fulfils the requirements for a present-day ventilation mode. An immediate complete healing of the lung damages was not found. Nevertheless, as a trend the length of ventilation support seems short. Even extensive osteosynthesis at multiple fractures was possible without delay. Side effects of the high opening pressure on the lung or other organs as well as sequels of the high intrinsic PEEP on liver, kidney or intestine were not found. The infection rate was low, therapeutic doses of antibiotics were necessary only in less than half of the ICU-stay.
Ventilation according the "open lung" approach is a very effective and safe way to ventilate patients after severe multiple trauma with accompanying thoracic trauma.
通气模式对重症监护病房（ICU）中多发伤患者的病程有明显影响。按照“肺开放”方法进行通气可迅速使肺不张区域复张。产生足够的内源性呼气末正压（PEEP）可保持肺开放。我们研究了“肺开放”方法对肺功能的影响，并监测了其对多发伤患者的副作用。
1999年5月至11月期间，18例连续的多发伤合并胸部外伤患者按照“肺开放”方法进行常规通气。我们主要关注肺力学、氧合和通气数据。监测对其他器官系统的副作用以及对感染率的影响。
按照“肺开放”方法进行通气可使严重多发伤伴胸部外伤患者早期获得充足的氧合和通气。该通气模式有助于预防气压伤、容积伤和肺不张伤，从而满足现代通气模式的要求。未发现肺损伤立即完全愈合的情况。然而，通气支持时间似乎有缩短的趋势。即使是多处骨折的广泛骨固定也可及时进行。未发现高开放压力对肺或其他器官的副作用以及高内源性PEEP对肝脏、肾脏或肠道的后遗症。感染率较低，仅不到一半的ICU住院时间需要使用治疗剂量的抗生素。
对于严重多发伤伴胸部外伤的患者，按照“肺开放”方法进行通气是一种非常有效且安全的通气方式。
