Baral P R, Bhattarai B, Pande R, Bhadani U, Bhattacharya A, Tripathi M
Department of Anaesthesiology, Kathmandu University Medical School, B & B Teaching Hospital, Susnari, Nepal.
Kathmandu Univ Med J (KUMJ). 2007 Jul-Sep;5(3):302-6.
To compare subjective experience of comfort associated with various commonly used supportive modes of mechanical ventilation for weaning in the intensive care unit (ICU).
The study was carried out in general ICU of a community-based teaching hospital in 30 healthy adult Nepalese volunteers of either sex and 19-37 years of age. The subjects were randomly made to experience breathing via anatomical facemask through ventilator circuit with synchronized intermittent mandatory ventilation (SIMV), assisted spontaneous breathing (ASB), biphasic positive airway pressure (BiPAP), and continuous positive airway pressure (CPAP) modes of ventilation with parameters set at intermediate level of respiratory support. Subjective comfort of breathing was noted using a 10 cm visual analogue scale (VAS) with no discomfort at one end and maximum imaginable discomfort at the other. Inspiratory and expiratory experience of discomfort was also noted using a four point ranking scale (0-no discomfort, 1-mild discomfort, 2-moderate discomfort and 3-severe discomfort). In addition, presence or absence of feeling of breathlessness and inflation was also noted.
BiPAP was the most comfortable mode of ventilation (p<0.01) on visual analogue scale. SIMV and CPAP modes were associated with higher discomfort than other modes during inspiratory and expiratory phases respectively. Breathlessness and inflation were least felt in BiPAP and SIMV modes respectively.
Perception of breathing comfort can vary widely with various supportive modes of ventilation in the ICU. Hence, no single supportive mode should be used in all patients during weaning from mechanical ventilation. Key words: assisted spontaneous breathing; biphasic positive airway pressure; breathing comfort; continuous positive airway pressure; mechanical ventilation; supportive modes synchronized intermittent mandatory ventilation; weaning.
比较重症监护病房（ICU）中各种常用的机械通气支持模式用于撤机时的主观舒适体验。
本研究在一家社区教学医院的综合ICU中对30名年龄在19至37岁之间、健康的成年尼泊尔志愿者（男女不限）进行。让受试者通过解剖面罩经呼吸机回路分别体验同步间歇指令通气（SIMV）、辅助自主呼吸（ASB）、双水平气道正压通气（BiPAP）和持续气道正压通气（CPAP）模式的呼吸，呼吸支持参数设置为中等水平。使用10厘米视觉模拟量表（VAS）记录呼吸的主观舒适度，量表一端表示无不适，另一端表示可想象到的最大不适。还使用四点分级量表（0 - 无不适，1 - 轻度不适，2 - 中度不适，3 - 重度不适）记录吸气和呼气时的不适体验。此外，还记录有无呼吸急促和胀满感。
在视觉模拟量表上，BiPAP是最舒适的通气模式（p<0.01）。SIMV和CPAP模式在吸气和呼气阶段分别比其他模式伴有更高的不适感。呼吸急促感在BiPAP模式中最少，胀满感在SIMV模式中最少。
在ICU中，不同的通气支持模式下呼吸舒适度的感知差异很大。因此，在机械通气撤机过程中，不应对所有患者都使用单一的支持模式。关键词：辅助自主呼吸；双水平气道正压通气；呼吸舒适度；持续气道正压通气；机械通气；支持模式；同步间歇指令通气；撤机
