von Goedecke Achim, Voelckel Wolfgang G, Wenzel Volker, Hörmann Christoph, Wagner-Berger Horst G, Dörges Volker, Lindner Karl H, Keller Christian
*Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Innsbruck, Austria; and †Department of Anesthesiology and Intensive Care Medicine, University Hospital of Kiel, Kiel, Germany.
Anesth Analg. 2004 Jan;98(1):260-263. doi: 10.1213/01.ANE.0000096190.36875.67.
One approach to make ventilation safer in an unprotected airway has been to limit tidal volumes; another one might be to limit peak airway pressure, although it is unknown whether adequate tidal volumes can be delivered. Accordingly, the purpose of this study was to evaluate the quality of automatic pressure-controlled ventilation versus manual circle system face-mask ventilation regarding ventilatory variables in an unprotected airway. We studied 41 adults (ASA status I-II) in a prospective, randomized, crossover design with both devices during the induction of anesthesia. Respiratory variables were measured with a pulmonary monitor (CP-100). Pressure-controlled mask ventilation versus circle system ventilation resulted in lower (mean +/- SD) peak airway pressures (10.6 +/- 1.5 cm H(2)O versus 14.4 +/- 2.4 cm H(2)O; P < 0.001), delta airway pressures (8.5 +/- 1.5 cm H(2)O versus 11.9 +/- 2.3 cm H(2)O; P < 0.001), expiratory tidal volume (650 +/- 100 mL versus 680 +/- 100 mL; P = 0.001), minute ventilation (10.4 +/- 1.8 L/min versus 11.6 +/- 1.8 L/min; P < 0.001), and peak inspiratory flow rates (0.81 +/- 0.06 L/s versus 1.06 +/- 0.26 L/s; P < 0.001) but higher inspiratory time fraction (48% +/- 0.8% versus 33% +/- 7.7%; P < 0.001) and end-tidal carbon dioxide (34 +/- 3 mm Hg versus 33 +/- 4 mm Hg; not significant). We conclude that in this model of apneic patients with an unprotected airway, pressure-controlled ventilation resulted in reduced inspiratory peak flow rates and peak airway pressures when compared with circle system ventilation, thus providing an additional patient safety effect during mask ventilation.
In this model of apneic patients with an unprotected airway, pressure-controlled ventilation resulted in reduced inspiratory peak flow rates and lower peak airway pressures when compared with circle system ventilation, thus providing an additional patient safety effect during face-mask ventilation.
在无保护气道情况下使通气更安全的一种方法是限制潮气量；另一种方法可能是限制气道峰压，尽管能否输送足够的潮气量尚不清楚。因此，本研究的目的是评估在无保护气道情况下，自动压力控制通气与手动环路系统面罩通气在通气变量方面的质量。我们采用前瞻性、随机、交叉设计，在41例成人（ASA分级I-II级）麻醉诱导期间使用这两种设备进行研究。使用肺监测仪（CP-100）测量呼吸变量。压力控制面罩通气与环路系统通气相比，气道峰压更低（均值±标准差，分别为10.6±1.5 cm H₂O和14.4±2.4 cm H₂O；P<0.001），气道压变化量更低（8.5±1.5 cm H₂O和11.9±2.3 cm H₂O；P<0.001），呼气潮气量更低（650±100 mL和680±100 mL；P = 0.001），分钟通气量更低（10.4±1.8 L/min和11.6±1.8 L/min；P<0.001），吸气峰流速更低（0.81±0.06 L/s和1.06±0.26 L/s；P<0.001），但吸气时间分数更高（48%±0.8%和33%±7.7%；P<0.001），呼气末二氧化碳分压更高（34±3 mmHg和33±4 mmHg；无显著差异）。我们得出结论，在这种无保护气道的呼吸暂停患者模型中，与环路系统通气相比，压力控制通气导致吸气峰流速和气道峰压降低，从而在面罩通气期间提供额外的患者安全保障。
在这种无保护气道的呼吸暂停患者模型中，与环路系统通气相比，压力控制通气导致吸气峰流速降低和气道峰压更低，从而在面罩通气期间提供额外的患者安全保障。
