Krismer Anette C, Wenzel Volker, Lindner Karl H, von Goedecke Achim, Junger Martin, Stadlbauer Karl H, Königsrainer Alfred, Strohmenger Hans-U, Sawires Martin, Jahn Beate, Hörmann Christoph
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
Crit Care Med. 2006 Aug;34(8):2175-81. doi: 10.1097/01.CCM.0000229886.98002.2B.
Outcome after trauma with severe hemorrhagic shock is still dismal. Since the majority of blood is present in the venous vessels, it might be beneficial to perform venous recruiting via the airway during severe hemorrhagic shock. Therefore, the purpose of our study was to evaluate the effects of negative expiratory pressure ventilation on mean arterial blood pressure, cardiac output, and short-term survival during severe hemorrhagic shock.
Prospective study in 21 laboratory animals.
University hospital research laboratory.
: Tyrolean domestic pigs.
After induction of controlled hemorrhagic shock (blood loss approximately 45 mL/kg), 21 pigs were randomly ventilated with either zero end-expiratory pressure (0 PEEP; n = 7), 5 cm H2O positive end-expiratory pressure (5 PEEP; n = 7), or negative expiratory pressure ventilation (up to -30 cm H2O at the endotracheal tube during expiration; n = 7).
Mean (+/-sd) arterial blood pressure was significantly higher in the negative expiratory pressure ventilation swine when compared with the 0 PEEP (38 +/- 5 vs. 27 +/- 3 mm Hg; p = .001) and the 5 PEEP animals (38 +/- 5 vs. 20 +/- 6 mm Hg; p < .001) after 5 mins of the experiment. Cardiac output was significantly higher in the negative expiratory pressure ventilation swine when compared with the 0 PEEP (3.1 +/- .4 vs. 1.9 +/- .9 L/min; p = .001) and 5 PEEP animals (3.1 +/- .4 vs. 1.2 +/- .8 L/min; p < .001) after 5 mins of the experiment. All seven negative expiratory pressure ventilation animals, but only three of seven 0 PEEP animals (p = .022), survived the 120-min study period, whereas all seven of seven 5 PEEP animals were dead within 35 mins (p < .001). Limitations include that blood loss was controlled and that the small sample size limits the evaluation of survival outcome.
When compared with pigs ventilated with either 0 PEEP or 5 PEEP, negative expiratory pressure ventilation during severe hemorrhagic shock improved mean arterial blood pressure and cardiac output.
严重失血性休克创伤后的预后仍然很差。由于大部分血液存在于静脉血管中，因此在严重失血性休克期间通过气道进行静脉血募集可能有益。因此，我们研究的目的是评估呼气负压通气对严重失血性休克期间平均动脉血压、心输出量和短期生存的影响。
对21只实验动物进行的前瞻性研究。
大学医院研究实验室。
蒂罗尔家猪。
在诱导控制性失血性休克（失血约45 mL/kg）后，21只猪被随机分为零呼气末正压通气组（0 PEEP；n = 7）、5 cm H2O呼气末正压通气组（5 PEEP；n = 7）或呼气负压通气组（呼气时气管插管处达-30 cm H2O；n = 7）。
实验5分钟后，呼气负压通气猪的平均（±标准差）动脉血压显著高于0 PEEP组（38±5 vs. 27±3 mmHg；p = 0.001）和5 PEEP组动物（38±5 vs. 20±6 mmHg；p < 0.001）。实验5分钟后，呼气负压通气猪的心输出量显著高于0 PEEP组（3.1±0.4 vs. 1.9±0.9 L/min；p = 0.001）和5 PEEP组动物（3.1±0.4 vs. 1.2±0.8 L/min；p < 0.001）。7只呼气负压通气动物全部存活至120分钟研究期结束，但7只0 PEEP动物中只有3只存活（p = 0.022），而7只5 PEEP动物在35分钟内全部死亡（p < 0.001）。局限性包括失血是可控的，且样本量小限制了生存结果的评估。
与采用0 PEEP或5 PEEP通气的猪相比，严重失血性休克期间的呼气负压通气改善了平均动脉血压和心输出量。
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