Tzoufi Maria, Mentzelopoulos Spyros D, Roussos Charis, Armaganidis Apostolos
*Department of Intensive Care Medicine, Attikon University Hospital; and †Department of Intensive Care Medicine, Evaggelismos General Hospital, Athens, Greece.
Anesth Analg. 2005 Sep;101(3):843-850. doi: 10.1213/01.ane.0000167276.92462.ba.
We hypothesized that combined salbutamol and external positive end-expiratory pressure (PEEPe) may present additive benefits in chronic obstructive pulmonary disease (COPD) exacerbation. In 10 anesthetized, mechanically ventilated, and bronchodilator-responsive COPD patients exhibiting moderate intrinsic PEEP (PEEPi), we assessed respiratory system (rs) mechanics, hemodynamics, and gas exchange at (a) baseline (zero PEEPe [ZEEPe]), (b) 30 min after 5 mg of nebulized salbutamol administration (ZEEPe-S), (c) 30 min after setting PEEPe at baseline PEEPi level (PEEPe), and (d) 30 min after 5 mg of nebulized salbutamol administration with PEEPe maintained unchanged (PEEPe-S). Return of determined variable values to baseline values was confirmed before PEEPe application. Relative to ZEEPe, (a) at ZEEP-S, PEEPi (4.8 +/- 0.7 versus 7.0 +/- 1.1 cm H(2)O), functional residual capacity change (115.6 +/- 23.1 versus 202.1 +/- 46.0 mL), minimal rs (airway) resistance (9.3 +/- 1.4 versus 11.8 +/- 2.2 cm H(2)O.L(-1).s(-1)), and additional rs resistance (5.2 +/- 1.4 versus 7.2 +/- 1.3 cm H(2)O.L(-1).s(-1)) were reduced (P < 0.01), and hemodynamics were improved; (b) at PEEPe, PEEPi (3.7 +/- 1.3 cm H(2)O) was reduced (P < 0.01), and gas exchange was improved; and (c) at PEEPe-S, PEEPi (2.0 +/- 1.2 cm H(2)O) was minimized, and rs mechanics (static rs elastance included), hemodynamics, and gas exchange were improved. Conclusively, in carefully preselected COPD patients, bronchodilation/PEEPe exhibits additive benefits.
我们假设，沙丁胺醇与外部呼气末正压（PEEPe）联合应用可能会在慢性阻塞性肺疾病（COPD）急性加重期带来额外益处。在10例麻醉、机械通气且对支气管扩张剂有反应的COPD患者中，这些患者存在中度内源性呼气末正压（PEEPi），我们在以下情况下评估了呼吸系统（rs）力学、血流动力学和气体交换：（a）基线（零PEEPe [ZEEPe]）；（b）雾化吸入5 mg沙丁胺醇后30分钟（ZEEPe-S）；（c）将PEEPe设置为基线PEEPi水平后30分钟（PEEPe）；（d）雾化吸入5 mg沙丁胺醇且PEEPe保持不变后30分钟（PEEPe-S）。在应用PEEPe之前，确认所测定变量值已恢复至基线值。相对于ZEEPe，（a）在ZEEP-S时，PEEPi（4.8±0.7对7.0±1.1 cm H₂O）、功能残气量变化（115.6±23.1对202.1±46.0 mL）、最小rs（气道）阻力（9.3±1.4对11.8±2.2 cm H₂O·L⁻¹·s⁻¹）和额外rs阻力（5.2±1.4对7.2±1.3 cm H₂O·L⁻¹·s⁻¹）降低（P<0.01），且血流动力学得到改善；（b）在PEEPe时，PEEPi（3.7±1.3 cm H₂O）降低（P<0.01），且气体交换得到改善；（c）在PEEPe-S时，PEEPi（2.0±1.2 cm H₂O）降至最低，rs力学（包括静态rs弹性）、血流动力学和气体交换均得到改善。总之，在经过精心预选的COPD患者中，支气管扩张/PEEPe显示出额外益处。
