对重症急性呼吸窘迫综合征患者采用吸气正压和高呼气末正压进行的一种肺复张手法的评估。

Evaluation of a recruitment maneuver with positive inspiratory pressure and high PEEP in patients with severe ARDS.

作者信息

Póvoa P, Almeida E, Fernandes A, Mealha R, Moreira P, Sabino H

机构信息

Unidade de Cuidados Intensivos, Hospital Garcia de Orta, Pragal, Almada, Portugal.

出版信息

Acta Anaesthesiol Scand. 2004 Mar;48(3):287-93. doi: 10.1111/j.0001-5172.2004.0305.x.

DOI:10.1111/j.0001-5172.2004.0305.x

PMID:14982560

Abstract

BACKGROUND

To evaluate the effect of a recruitment maneuver (RM) with constant positive inspiratory pressure and high positive end-expiratory pressure (PEEP) on oxygenation and static compliance (Cs) in patients with severe acute respiratory distress syndrome (ARDS).

METHODS

Eight patients with ARDS ventilated with lung-protective strategy and an arterial partial pressure of oxygen to inspired oxygen fraction ratio (PaO2/FIO2) < or =100 mmHg regardless of PEEP were prospectively studied. The RM was performed in pressure-controlled ventilation at FIO2 of 1.0 until PaO2 reached 250 mmHg or a maximal plateau pressure/PEEP of 60/45 cmH2O was achieved. The RM was performed with stepwise increases of 5 cmH2O of PEEP every 2 min and thereafter with stepwise decreases of 2 cmH2O of PEEP every 2 min until a drop in PaO2 >10% below the recruitment PEEP level. Data was collected before (preRM), during and after 30 min (posRM).

RESULTS

The PaO2/FIO2 increased from 83 +/- 22 mmHg preRM to 118 +/- 32 mmHg posRM (P = 0.001). The Cs increased from 28 +/- 10 ml cmH2O(-1) preRM to 35 +/- 12 ml cmH2O(-1) posRM (P = 0.025). The PEEP was 12 +/- 3 cmH2O preRM and was set at 15 +/- 4 cmH2O posRM (P = 0.025). The PEEP of recruitment was 36 +/- 9 cmH2O and the collapsing PEEP was 13 +/- 4 cmH2O. The PaO2 of recruitment was 225 +/- 105 mmHg, with five patients reaching a PaO2 > or = 250 mmHg. The FIO2 decreased from 0.76 +/- 0.16 preRM to 0.63 +/- 0.15 posRM (P = 0.001). No major complications were detected.

CONCLUSION

Recruitment maneuver was safe and useful to improve oxygenation and Cs in patients with severe ARDS ventilated with lung-protective strategy.

摘要

背景

评估采用持续气道正压通气和高呼气末正压（PEEP）的肺复张手法（RM）对重症急性呼吸窘迫综合征（ARDS）患者氧合及静态顺应性（Cs）的影响。

方法

对8例采用肺保护性通气策略、无论PEEP水平如何动脉血氧分压与吸入氧分数比值（PaO₂/FIO₂）≤100 mmHg的ARDS患者进行前瞻性研究。在压力控制通气模式下，吸入氧分数（FIO₂）为1.0时进行RM，直至PaO₂达到250 mmHg或达到最大平台压/PEEP为60/45 cmH₂O。RM过程中，每2分钟将PEEP逐步增加5 cmH₂O，此后每2分钟将PEEP逐步降低2 cmH₂O，直至PaO₂较肺复张PEEP水平下降>10%。在肺复张手法前（preRM）、过程中及30分钟后（posRM）收集数据。

结果

PaO₂/FIO₂从肺复张手法前的83±22 mmHg升至肺复张手法后的118±32 mmHg（P = 0.001）。Cs从肺复张手法前的28±10 ml cmH₂O⁻¹升至肺复张手法后的35±12 ml cmH₂O⁻¹（P = 0.025）。PEEP在肺复张手法前为12±3 cmH₂O，在肺复张手法后设定为15±4 cmH₂O（P = 0.025）。肺复张时的PEEP为36±9 cmH₂O，塌陷PEEP为13±4 cmH₂O。肺复张时的PaO₂为225±105 mmHg，5例患者PaO₂≥250 mmHg。FIO₂从肺复张手法前的0.76±0.16降至肺复张手法后的0.63±0.15（P = 0.001）。未发现重大并发症。