俯卧位通气与吸入一氧化氮：急性呼吸窘迫综合征的协同治疗方法

Prone positioning and inhaled nitric oxide: synergistic therapies for acute respiratory distress syndrome.

作者信息

Johannigman J A, Davis K, Miller S L, Campbell R S, Luchette F A, Frame S B, Branson R D

机构信息

Department of Surgery, University of Cincinnati, College of Medicine, Ohio 45267-0558, USA.

出版信息

J Trauma. 2001 Apr;50(4):589-95; discussion 595-6. doi: 10.1097/00005373-200104000-00001.

DOI:10.1097/00005373-200104000-00001

PMID:11318005

Abstract

BACKGROUND

Inhaled nitric oxide (INO) and prone positioning have both been advocated as methods to improve oxygenation in patients with acute respiratory distress syndrome (ARDS). This study was designed to evaluate the relative contributions of INO and prone positioning alone and in combination on gas exchange in trauma patients with ARDS.

METHODS

Sixteen patients meeting the consensus definition of ARDS were studied. Patients received mechanical ventilation in the supine position, mechanical ventilation plus INO at 1 part per million in the supine position, mechanical ventilation in the PP, and mechanical ventilation in the prone positioning plus INO at 1 part per million. A stabilization period of 1 hour was allowed at each condition. After stabilization,hemodynamic and gas exchange variables were measured.

RESULTS

INO and prone positioning both increased PaO2/FIO2 compared with ventilation in the supine position. PaO2/FIO2 increased by 14% during use of INO, and 10 of 16 patients (62%) responded to INO in the supine position. PaO2/FIO2 increased by 33%, and 14 of 16 patients (87.5%) responded to the prone position. The combination of INO and prone positioning resulted in an improvement in PaO2/FIO2 in 15 of 16 patients(94%), with a mean increase in PaO2/FIO2 of 59%. Pulmonary vascular resistance was reduced during use of INO, with a greater reduction in pulmonary vascular resistance seen with INO plus prone positioning (175 +/- 36 dynes x s/cm5 vs. 134 +/- 28 dynes x s/cm5) compared with INO in the supine position (164 +/- 48 dynes x s/cm5 vs.138 +/- 44 dynes x s/cm5). There were no significant hemodynamic effects of INO or prone positioning and no complications were seen during this relative short duration of study.

CONCLUSIONS

INO and prone positioning can contribute to improved oxygenation in patients with ARDS. The two therapies in combination are synergistic and may be important adjuncts to mechanical ventilation in the ARDS patient with refractory hypoxemia.

摘要

背景

吸入一氧化氮（INO）和俯卧位通气均被推荐为改善急性呼吸窘迫综合征（ARDS）患者氧合的方法。本研究旨在评估INO和俯卧位通气单独及联合应用对创伤后ARDS患者气体交换的相对作用。

方法

对16例符合ARDS共识定义的患者进行研究。患者依次接受仰卧位机械通气、仰卧位机械通气加百万分之一的INO、俯卧位机械通气以及俯卧位机械通气加百万分之一的INO。每种情况均给予1小时的稳定期。稳定后，测量血流动力学和气体交换变量。

结果

与仰卧位通气相比，INO和俯卧位通气均提高了动脉血氧分压/吸入氧分数值（PaO2/FIO2）。使用INO期间，PaO2/FIO2升高了14%，16例患者中有10例（62%）在仰卧位时对INO有反应。PaO2/FIO2升高了33%，16例患者中有14例（87.5%）对俯卧位有反应。INO与俯卧位通气联合应用使16例患者中的15例（94%）PaO2/FIO2得到改善，PaO2/FIO2平均升高59%。使用INO期间肺血管阻力降低，与仰卧位INO（164±48达因×秒/厘米⁵ vs. 138±44达因×秒/厘米⁵）相比，INO加俯卧位通气时肺血管阻力降低更明显（175±36达因×秒/厘米⁵ vs. 134±28达因×秒/厘米⁵）。INO或俯卧位通气对血流动力学无显著影响，且在相对较短的研究期间未观察到并发症。