使用动物模型研究持续气道正压通气/呼气末正压通气及压力支持通气对呼吸功的影响。

Effects of continuous positive airway pressure/positive end-expiratory pressure and pressure-support ventilation on work of breathing, using an animal model.

作者信息

Heulitt Mark J, Holt Shirley J, Wilson Sterling, Hall Renée A

机构信息

Department of Pediatrics, University of Arkansas for Medical Science and Arkansas Children's Hospital, Little Rock AR 72202, USA.

出版信息

Respir Care. 2003 Jul;48(7):689-96.

PMID:12841860

Abstract

OBJECTIVE

Evaluate the effects of continuous positive airway pressure (CPAP)/positive end-expiratory pressure (PEEP) and pressure support ventilation (PSV) on work of breathing (WOB).

METHODS

With 13 anesthetized lambs we measured WOB with an esophageal balloon and flow signals. All the animals were sedated, intubated, and ventilated, using 2 pediatric ventilators (Servo 300 and VIP Bird). Ventilator settings were CPAP of 0, 5, and 10 cm H(2)O and PSV of 5 and 10 cm H(2)O with PEEP of 0, 5, and 10 cm H(2)O. Data were analyzed with 2-way analysis of variance.

RESULTS

With the Servo 300 the total WOB (WOB(T)) increased between CPAP/PEEP of 0 and 10 cm H(2)O (p </= 0.0001) and between CPAP/PEEP of 5 and 10 cm H(2)O (p </= 0.0002). With the Servo 300 the addition of PSV decreased WOB(T) (p </= 0.003). With the VIP Bird the WOB(T) significantly increased between CPAP/PEEP of 0 and 10 cm H(2)O (p </= 0.02) and between CPAP/PEEP of 5 and 10 cm H(2)O (p </= 0.03). With PSV the WOB(T) was lower only at PSV 10 cm H(2)O (p </= 0.0001).

CONCLUSIONS

WOB(T) increased as CPAP/PEEP was increased, and PSV lowered WOB(T.) We hypothesize that in a healthy animal model increased CPAP/PEEP may cause alveolar overdistention.

摘要

目的

评估持续气道正压通气（CPAP）/呼气末正压通气（PEEP）和压力支持通气（PSV）对呼吸功（WOB）的影响。

方法

使用食管气囊和流量信号，对13只麻醉的羔羊进行呼吸功测量。所有动物均使用2台小儿呼吸机（Servo 300和VIP Bird）进行镇静、插管和通气。呼吸机设置为CPAP分别为0、5和10 cmH₂O，PSV分别为5和10 cmH₂O，PEEP分别为0、5和10 cmH₂O。数据采用双向方差分析。

结果

使用Servo 300时，CPAP/PEEP从0 cmH₂O增加到10 cmH₂O时总呼吸功（WOB(T)）增加（p≤0.0001），CPAP/PEEP从5 cmH₂O增加到10 cmH₂O时也增加（p≤0.0002）。使用Servo 300时，添加PSV可降低WOB(T)（p≤0.003）。使用VIP Bird时，CPAP/PEEP从0 cmH₂O增加到10 cmH₂O时WOB(T)显著增加（p≤0.02），CPAP/PEEP从5 cmH₂O增加到10 cmH₂O时也增加（p≤0.03）。使用PSV时，仅在PSV为10 cmH₂O时WOB(T)较低（p≤0.0001）。