Natalini G, Cavaliere S, Seramondi V, Foccoli P, Vitacca M, Ambrosino N, Candiani A
Department of Anesthesia and Intensive, University of Brescia, Italy.
Chest. 2000 Jul;118(1):18-23. doi: 10.1378/chest.118.1.18.
To compare the effectiveness of two modalities of external ventilation during rigid bronchoscopy: intermittent negative pressure ventilation (INPV) and external high-frequency oscillation (EHFO).
Prospective, controlled, randomized, nonblinded study.
University-affiliated hospital.
Seventy patients undergoing interventional rigid bronchoscopy for tracheobronchial lesions were enrolled into the study.
Mechanical ventilation was performed by INPV or EHFO. When pulse oximetry was < 90%, manually assisted ventilation was delivered.
Arterial blood gases were sampled preoperatively and intraoperatively. Most patients in both groups had normal intraoperative PaCO(2) (mean, 43. 6 +/- 11.8 mm Hg under EHFO and 37.4 +/- 8.2 mm Hg under INPV; p = 0.012), and acidemia occurred in 9 of 35 patients of EHFO group and in 2 of 35 patients of INPV group (p = 0.049). Hypercapnia (PaCO(2) > 50 mm Hg) was observed in 10 patients under EHFO and in 2 with INPV (p = 0.026). Intraoperative mean PaO(2) was similar (101.4 +/- 52.9 mm Hg with EHFO and 124.2 +/- 50.3 mm Hg with INPV; p = 0.07), but O(2) supply was different (3.5 +/- 2.3 L/min during INPV and 8.5 +/- 6.2 L/min during EHFO; p < 0.001). Intraoperative hypoxemia (PaO(2) < 60 mm Hg) occurred in five patients with EHFO and two with INPV (p = 0.426). Three EHFO patients required manually assisted ventilation (mean, 0.2 +/- 0.9), but no INPV patient did (p = 0.142).
External negative pressure ventilation appears to be a suitable choice during rigid bronchoscopy: both EHFO and INPV ensure effective ventilation and comfortable operating conditions in the majority of patients. Some patients may receive inadequate ventilation with EHFO, developing respiratory acidosis and requiring manually assisted ventilation. In comparison with INPV, EHFO requires a higher fraction of inspired oxygen.
比较硬质支气管镜检查期间两种体外通气方式的有效性：间歇性负压通气（INPV）和体外高频振荡（EHFO）。
前瞻性、对照、随机、非盲法研究。
大学附属医院。
70例因气管支气管病变接受介入性硬质支气管镜检查的患者纳入本研究。
通过INPV或EHFO进行机械通气。当脉搏血氧饱和度<90%时，进行手动辅助通气。
术前和术中采集动脉血气样本。两组中的大多数患者术中PaCO₂正常（EHFO组平均为43.6±11.8 mmHg，INPV组为37.4±8.2 mmHg；p = 0.012），EHFO组35例患者中有9例发生酸血症，INPV组35例患者中有2例发生酸血症（p = 0.049）。EHFO组10例患者和INPV组2例患者出现高碳酸血症（PaCO₂>50 mmHg）（p = 0.026）。术中平均PaO₂相似（EHFO组为101.4±52.9 mmHg，INPV组为124.2±50.3 mmHg；p = 0.07），但氧气供应不同（INPV期间为3.5±2.3 L/min，EHFO期间为8.5±6.2 L/min；p<0.001）。EHFO组5例患者和INPV组2例患者术中发生低氧血症（PaO₂<60 mmHg）（p = 0.426）。3例EHFO患者需要手动辅助通气（平均为0.2±0.9），但INPV组患者均不需要（p = 0.142）。
体外负压通气似乎是硬质支气管镜检查期间的合适选择：EHFO和INPV均可确保大多数患者有效通气和舒适的手术条件。部分患者使用EHFO可能通气不足，出现呼吸性酸中毒并需要手动辅助通气。与INPV相比，EHFO需要更高的吸入氧分数。
