Moritz Fabienne, Benichou Jacques, Vanheste Marc, Richard Jean-Christophe, Line Sebastien, Hellot Marie-France, Bonmarchand Guy, Muller Jean-Michel
Emergency Department, CHU de Rouen, Hôpital Charles Nicolle, 1 rue de Germont, 76031 Rouen Cedex, France.
Eur J Emerg Med. 2003 Sep;10(3):204-8. doi: 10.1097/00063110-200309000-00009.
This study aimed to assess the short-term respiratory effects of a new portable device that delivers a continuous positive airway pressure via a face mask (Boussignac-CPAP) in patients with severe acute cardiogenic pulmonary oedema, and the feasibility of using this technique in an emergency department. We prospectively studied 30 consecutive patients with acute cardiogenic pulmonary oedema. They were randomly assigned either to the Boussignac-CPAP valve, which delivered oxygen, or to standard oxygen delivery for a duration of 30 min. The end-expiratory pressure reached 9.3+/-0.3 cm H2O with the Boussignac-CPAP valve. At the end of the 30 min period, the decreases in respiratory rate and muscular activity were significantly greater among patients assigned to the Boussignac-CPAP valve compared with those on standard oxygen delivery [24+/-1.6 breaths/min, median 24 (15-37) versus 28.5+/-1.9, median 27 (16-38) and 1.3+/-0.2, median 1 (0-4) versus 2.7+/-0.3, median 2 (0-4), respectively]. Moreover, the arterial oxygen tension to inspired oxygen concentration ratio and tidal volume were improved at the end of the 30 min Boussignac-CPAP period compared with baseline. Boussignac-CPAP was easily implemented and no side-effects were reported. Continuous positive pressure delivered using the Boussignac-CPAP device is feasible in an emergency care setting. It can quickly improve respiratory distress in acute cardiogenic pulmonary oedema patients. A larger trial should be initiated in such an emergency care setting to demonstrate the effectiveness of the Boussignac-CPAP device.
本研究旨在评估一种通过面罩输送持续气道正压的新型便携式设备（布西尼亚克持续气道正压通气，Boussignac-CPAP）对重症急性心源性肺水肿患者的短期呼吸影响，以及在急诊科使用该技术的可行性。我们前瞻性地研究了30例连续的急性心源性肺水肿患者。他们被随机分配至输送氧气的布西尼亚克持续气道正压通气阀组或标准氧气输送组，持续30分钟。使用布西尼亚克持续气道正压通气阀时，呼气末压力达到9.3±0.3 cmH₂O。在30分钟时间段结束时，与接受标准氧气输送的患者相比，分配至布西尼亚克持续气道正压通气阀组的患者呼吸频率和肌肉活动的下降幅度显著更大[分别为24±1.6次/分钟，中位数24（15 - 37）与28.5±1.9次/分钟，中位数27（16 - 38）；以及1.3±0.2，中位数1（0 - 4）与2.7±0.3，中位数2（0 - 4）]。此外，与基线相比，在布西尼亚克持续气道正压通气30分钟结束时，动脉血氧分压与吸入氧浓度比值及潮气量均有所改善。布西尼亚克持续气道正压通气易于实施，且未报告有副作用。在急诊护理环境中，使用布西尼亚克持续气道正压通气设备输送持续正压是可行的。它可迅速改善急性心源性肺水肿患者的呼吸窘迫。应在这种急诊护理环境中开展更大规模的试验，以证明布西尼亚克持续气道正压通气设备的有效性。
