Sancho Jesús, Servera Emilio, Vergara Pedro, Marín Julio
Department of Respirtaory Medicine, Hospital Clínico Universitario, Universitat de Valencia, Spain.
Am J Phys Med Rehabil. 2003 Oct;82(10):750-3. doi: 10.1097/01.PHM.0000087456.28979.2E.
To compare the effects of mechanical insufflation-exsufflation vs. suctioning via tracheostomy tubes on respiratory variables for six amyotrophic lateral sclerosis patients.
In this prospective crossover study, six consecutive patients with amyotrophic lateral sclerosis who required continuous mechanical ventilation via tracheostomy tubes and developed chest infections underwent measurement of pulse oxyhemoglobin saturation (SpO2), peak inspiratory pressure (PIP), mean airway pressure (Pawm), and work of breathing performed by the ventilator (WOBv) at baseline and 5 and 30 min after tracheal suctioning and 5 min after mechanical insufflation-exsufflation.
The baseline values were 93.50 +/- 2.26% for SpO2 in ambient air, 18.50 +/- 4.23 cm H2O for PIP, 4.67 +/- 1.37 cm H2O for Pawm, and 1.03 +/- 0.25 J/liters for WOBv. Only WOBv changed significantly, decreasing after tracheal suctioning (P < 0.05), whereas all variables improved significantly after mechanical insufflation-exsufflation.
For ventilator-dependent patients with amyotrophic lateral sclerosis, mechanical insufflation-exsufflation via a tracheostomy tube with an inflated cuff may be more effective in eliminating airway secretions than conventional tracheal suctioning.
比较机械通气与经气管切开套管吸痰对6例肌萎缩侧索硬化症患者呼吸变量的影响。
在这项前瞻性交叉研究中，6例连续的肌萎缩侧索硬化症患者，他们需要通过气管切开套管进行持续机械通气并发生了胸部感染，在基线、气管吸痰后5分钟和30分钟以及机械通气后5分钟测量脉搏氧合血红蛋白饱和度（SpO2）、吸气峰压（PIP）、平均气道压（Pawm）和呼吸机所做的呼吸功（WOBv）。
在环境空气中SpO2的基线值为93.50±2.26%，PIP为18.50±4.23 cmH2O，Pawm为4.67±1.37 cmH2O，WOBv为1.03±0.25 J/升。只有WOBv有显著变化，气管吸痰后降低（P<0.05），而所有变量在机械通气后均有显著改善。
对于依赖呼吸机的肌萎缩侧索硬化症患者，通过带充气套囊的气管切开套管进行机械通气可能比传统的气管吸痰在清除气道分泌物方面更有效。
