Trachsel D, Erb T O, Frei F J, Hammer J
Division of Paediatric Intensive Care and Pulmonology, University Children's Hospital of Basel, Post Office Box, 4005 Basel, Switzerland.
Eur Respir J. 2005 Nov;26(5):773-7. doi: 10.1183/09031936.05.00029405.
Young children are at increased risk for hypoxaemia and hypercapnia during flexible bronchoscopy due to the small size and increased collapsibility of their airways. Various strategies are used to prevent hypoventilation and to provide oxygen during the procedure. The aim of this study was to assess the impact of continuous positive airway pressure (CPAP) on ventilation during flexible bronchoscopy in infants and young children. Tidal breathing was measured in 16 spontaneously breathing and deeply sedated children, aged 3-25 months, by ultrasound spirometry via an airway endoscopy mask. Measurements were made with the tip of the bronchoscope positioned in the pharynx with no CPAP, and in mid-trachea with 0, 5 and 10 cmH2O of CPAP. Transition of the bronchoscope through the vocal cords was associated with significant decreases of tidal volumes (5.0+/-0.5 versus 3.4+/-0.5 mL.kg(-1)), peak tidal expiratory flows (78+/-12 versus 52+/-10 mL.s(-1)) and peak tidal inspiratory flows (98+/-15 versus 66+/-12 mL.kg(-1)). CPAP (5-10 cmH2O) induced almost complete reversal of these changes. In conclusion, it is shown here that flexible bronchoscopy in spontaneously breathing young children is associated with significant decreases in tidal volume and respiratory flow. These changes are largely reversible with continuous positive airway pressure.
由于幼儿气道管径小且可塌陷性增加，在可弯曲支气管镜检查期间发生低氧血症和高碳酸血症的风险更高。在操作过程中，人们采用了各种策略来预防通气不足并提供氧气。本研究的目的是评估持续气道正压通气（CPAP）对婴幼儿可弯曲支气管镜检查期间通气的影响。通过气道内窥镜面罩，采用超声肺量计对16名年龄在3至25个月、自主呼吸且深度镇静的儿童进行潮气量测量。在支气管镜尖端位于咽部且无CPAP时以及位于气管中部且CPAP分别为0、5和10 cmH₂O时进行测量。支气管镜通过声带时，潮气量（5.0±0.5对3.4±0.5 mL·kg⁻¹）、呼气潮气量峰值（78±12对52±10 mL·s⁻¹）和吸气潮气量峰值（98±15对66±12 mL·kg⁻¹）均显著下降。CPAP（5至10 cmH₂O）几乎完全逆转了这些变化。总之，本研究表明，自主呼吸的幼儿进行可弯曲支气管镜检查时，潮气量和呼吸流量会显著下降。通过持续气道正压通气，这些变化在很大程度上是可逆的。
