East T D, Böhm S H, Wallace C J, Clemmer T P, Weaver L K, Orme J F, Morris A H
Department of Internal Medicine, LDS Hospital, Salt Lake City 84143.
Chest. 1992 Mar;101(3):697-710. doi: 10.1378/chest.101.3.697.
We have developed a computerized protocol that provides a systematic approach for management of pressure control-inverse ratio ventilation (PCIRV). The protocols were used for 1,466 h in ten around-the-clock PCIRV evaluations on seven patients with severe adult respiratory distress syndrome (ARDS). Patient therapy was controlled by protocol 95 percent of the time (1,396 of 1,466 h) and 90 percent of the protocol instructions (1,937 of 2,158) were followed by the clinical staff. Of the 221 protocol instructions, 88 (39 percent) not followed were due to invalid PEEPi measurements. Compared with preceding values during CPPV, the expired minute ventilation was reduced by 27 percent during PCIRV while maintaining a pH that was not clinically different (mean difference in pH = 0.02). There was no difference in the PaO2, PEEPi, or the FIO2 between PCIRV and CPPV. The PEEP setting was reduced by 33 percent from 9 +/- 0.05 to 6 +/- 0.6 and the I:E ratio increased from 0.64 +/- 0.04 to 2.3 +/- 0.10. Peak airway pressure was reduced by 24 percent (from 59 +/- 1.5 to 45 +/- 0.6) and mean airway pressure increased by 27 percent (from 22 +/- 0.8 to 28 +/- 0.6) in PCIRV. Right atrial and pulmonary artery pressures were higher and cardiac output lower in PCIRV but blood pressure was unchanged. The success of this protocol has demonstrated the feasibility of using PEEPi as a primary control variable for oxygenation. This computerized PCIRV protocol should make the future use of PCIRV less mystifying, simpler, and more systematic.
我们已经开发出一种计算机化方案，该方案为压力控制反比通气（PCIRV）的管理提供了一种系统方法。该方案在对7例严重成人呼吸窘迫综合征（ARDS）患者进行的7次昼夜PCIRV评估中使用了1466小时。患者治疗在95%的时间内（1466小时中的1396小时）由方案控制，临床工作人员遵循了90%的方案指令（2158条中的1937条）。在221条方案指令中，88条（39%）未被遵循是由于无效的内源性呼气末正压（PEEPi）测量。与持续气道正压通气（CPPV）期间的先前值相比，PCIRV期间呼出分钟通气量减少了27%，同时维持了临床上无差异的pH值（pH值的平均差异=0.02）。PCIRV和CPPV之间的动脉血氧分压（PaO2）、PEEPi或吸入氧分数（FIO2）没有差异。呼气末正压（PEEP）设置从9±0.05降至6±0.6，降低了33%，吸呼比从0.64±0.04增加到2.3±0.10。PCIRV中气道峰值压力降低了24%（从59±1.5降至45±0.6），平均气道压力增加了27%（从22±0.8升至28±0.6）。PCIRV中右心房和肺动脉压力较高，心输出量较低，但血压未变。该方案的成功证明了将PEEPi用作氧合的主要控制变量的可行性。这种计算机化的PCIRV方案应使PCIRV的未来使用不那么神秘、更简单且更系统。
