Kindgen-Milles Detlef, Müller Eckhard, Buhl Rolf, Böhner Hinrich, Ritter Dennis, Sandmann Wilhelm, Tarnow Jörg
Department of Anesthesiology, University Hospital, Düsseldorf, Germany.
Chest. 2005 Aug;128(2):821-8. doi: 10.1378/chest.128.2.821.
Patients who undergo surgical repair of thoracoabdominal aortic aneurysms have a high risk for the development of respiratory complications, which cause significant postoperative morbidity and prolong hospitalization, compared to patients who undergo other types of surgery. We studied whether prophylactic noninvasive application of nasal continuous positive airway pressure (nCPAP) administered via a facemask immediately after extubation may reduce pulmonary morbidity and shorten the length of hospitalization.
Prospective randomized clinical trial.
Surgical ICU of a university hospital.
Fifty-six patients following elective prosthetic replacement of the thoracoabdominal aorta, of whom 6 patients were excluded because they had received prolonged mechanical ventilation.
Following extubation in the ICU, nCPAP was applied for 12 to 24 h at an airway pressure of 10 cm H2O to patients in the study group (n = 25). Subjects in the control group (n = 25) received standard treatment including intermittent nCPAP (10 cm H2O for 10 min) every 4 h.
In the study group, nCPAP was applied for a mean (+/- SD) duration of 23 +/- 3 h at an airway pressure of 10 +/- 1 cm H2O, which improved pulmonary oxygen transfer without altering hemodynamics (ie, heart rate, mean arterial BP, and central venous pressure). The application of nCPAP was associated with fewer pulmonary complications (Pa(O2)/fraction of inspired oxygen [F(IO2)] <100, atelectasis, pneumonia, reintubation rate) compared to the control group (7 of 25 patients vs 24 of 25 subjects, respectively; p = 0.019). The mean duration of intensive care treatment tended to be shorter in the study group compared to the control group (8 +/- 1 vs 12 +/- 2 days, respectively; difference not significant), while the mean length of hospital stay was shorter with nCPAP therapy (22 +/- 2 vs 34 +/- 5 days, respectively; p = 0.048).
The prophylactic application of nCPAP at airway pressures of 10 cm H2O significantly reduced pulmonary morbidity and length of hospital stay following the surgical repair of thoracoabdominal aortic aneurysms. Thus, it can be recommended as a standard treatment procedure for this patient group.
与接受其他类型手术的患者相比，接受胸腹主动脉瘤手术修复的患者发生呼吸并发症的风险较高，呼吸并发症会导致显著的术后发病率并延长住院时间。我们研究了在拔管后立即通过面罩预防性无创应用鼻持续气道正压通气（nCPAP）是否可以降低肺部发病率并缩短住院时间。
前瞻性随机临床试验。
大学医院的外科重症监护病房。
56例接受胸腹主动脉择期人工血管置换术的患者，其中6例因接受长时间机械通气而被排除。
在重症监护病房拔管后，研究组（n = 25）的患者以10 cm H2O的气道压力接受nCPAP治疗12至24小时。对照组（n = 25）的受试者接受标准治疗，包括每4小时进行一次间歇性nCPAP（10 cm H2O，持续10分钟）。
在研究组中，nCPAP在10±1 cm H2O的气道压力下平均（±标准差）应用23±3小时，这改善了肺氧输送而未改变血流动力学（即心率、平均动脉血压和中心静脉压）。与对照组相比，nCPAP的应用与更少的肺部并发症相关（动脉血氧分压/吸入氧分数[F(IO2)]<100、肺不张、肺炎、再次插管率）（分别为25例患者中的7例与25例受试者中的24例；p = 0.019）。与对照组相比，研究组的重症监护治疗平均持续时间倾向于更短（分别为8±1天与12±2天；差异无统计学意义），而nCPAP治疗的平均住院时间更短（分别为22±2天与34±5天；p = 0.048）。
在气道压力为10 cm H2O时预防性应用nCPAP可显著降低胸腹主动脉瘤手术修复后的肺部发病率和住院时间。因此，它可被推荐作为该患者群体的标准治疗程序。
