Sarnaik Ashok P, Daphtary Kshama M, Meert Kathleen L, Lieh-Lai Mary W, Heidemann Sabrina M
Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI 48201, USA.
Pediatr Crit Care Med. 2004 Mar;5(2):133-8. doi: 10.1097/01.pcc.0000112374.68746.e8.
The optimum strategy for mechanical ventilation in a child with status asthmaticus is not established. Volume-controlled ventilation continues to be the traditional approach in such children. Pressure-controlled ventilation may be theoretically more advantageous in allowing for more uniform ventilation. We describe our experience with pressure-controlled ventilation in children with severe respiratory failure from status asthmaticus.
Retrospective review.
Pediatric intensive care unit in a university-affiliated children's hospital.
All patients who received mechanical ventilation for status asthmaticus.
Pressure-controlled ventilation was used as the initial ventilatory strategy. The optimum pressure control, rate, and inspiratory and expiratory time were determined based on blood gas values, flow waveform, and exhaled tidal volume.
Forty patients were admitted for 51 episodes of severe status asthmaticus requiring mechanical ventilation. Before the institution of pressure-controlled ventilation, median pH and Pco(2) were 7.21 (range, 6.65-7.39) and 65 torr (29-264 torr), respectively. Four hours after pressure-controlled ventilation, median pH increased to 7.31 (6.98-7.45, p <.005), and Pco(2) decreased to 41 torr (21-118 torr, p <.005). For patients with respiratory acidosis (Pco(2) >45 torr) within 1 hr of starting pressure-controlled ventilation, the median length of time until Pco(2) decreased to <45 torr was 5 hrs (1-51 hrs). Oxygen saturation was maintained >95% in all patients. Two patients had pneumomediastinum before pressure-controlled ventilation. One patient each developed pneumothorax and subcutaneous emphysema after initiation of pressure-controlled ventilation. All patients survived without any neurologic morbidity. Median duration of mechanical ventilation was 29 hrs (4-107 hrs), intensive care stay was 56 hrs (17-183 hrs), and hospitalization was 5 days (2-20 days).
Based on this retrospective study, we suggest that pressure-controlled ventilation is an effective ventilatory strategy in severe status asthmaticus in children. Pressure-controlled ventilation represents a therapeutic option in the management of such children.
哮喘持续状态患儿机械通气的最佳策略尚未确立。容量控制通气仍是此类患儿的传统方法。理论上，压力控制通气在实现更均匀通气方面可能更具优势。我们描述了我们在哮喘持续状态导致严重呼吸衰竭的患儿中应用压力控制通气的经验。
回顾性研究。
一所大学附属医院的儿科重症监护病房。
所有因哮喘持续状态接受机械通气的患者。
压力控制通气被用作初始通气策略。根据血气值、流量波形和呼出潮气量确定最佳压力控制、频率以及吸气和呼气时间。
40例患者因51次严重哮喘持续状态发作入院并需要机械通气。在采用压力控制通气之前，pH值中位数为7.21（范围6.65 - 7.39），二氧化碳分压（Pco₂）中位数为65托（29 - 264托）。压力控制通气4小时后，pH值中位数升至7.31（6.98 - 7.45，p <.005），Pco₂降至41托（21 - 118托，p <.005）。对于在开始压力控制通气1小时内存在呼吸性酸中毒（Pco₂ > 45托）的患者，Pco₂降至< 45托的中位时间为5小时（1 - 51小时）。所有患者的氧饱和度均维持在> 95%。2例患者在压力控制通气前发生纵隔气肿。1例患者在开始压力控制通气后发生气胸，1例发生皮下气肿。所有患者均存活，无任何神经功能障碍。机械通气的中位持续时间为29小时（4 - 107小时），重症监护病房停留时间为56小时（17 - 183小时），住院时间为5天（2 - 20天）。
基于这项回顾性研究，我们认为压力控制通气是儿童严重哮喘持续状态的一种有效通气策略。压力控制通气是此类患儿治疗的一种选择。
