在模拟未插管呼吸骤停患者的实验台模型中，针对气道阻塞的通气策略。

Herff Holger, Paal Peter, von Goedecke Achim, Mitterlechner Thomas, Schmittinger Christian A, Wenzel Volker

Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.

Anesth Analg. 2009 May;108(5):1585-8. doi: 10.1213/ane.0b013e31819f32a6.

BACKGROUND

The Smart Bag MO(R) is an adult flow-limited bag-valve device designed to reduce the risk of stomach inflation in an unprotected airway. Its properties in severe airway obstruction are as yet unknown.

METHODS

In a bench model, we evaluated respiratory mechanics and delivered tidal volumes although ventilating at airway resistances of 4, 10, and 20 cm H(2)O . L(-1) . s(-1) once with a flow-limited bag-valve device and once with a standard bag-valve device to simulate a respiratory arrest patient with an unprotected airway.

RESULTS

Inspiratory times were always longer with the flow-limited bag-valve device than with the standard bag-valve device. Lung tidal volume in the simulated unobstructed airway was 750 +/- 70 mL using the flow-limited bag-valve device versus 780 +/- 30 mL using the standard bag-valve device (n.s.); in the simulated medium obstructed airway it was 800 +/- 70 versus 850 +/- 20 mL (n.s.), and in the simulated severely obstructed airway it was 210 +/- 20 versus 170 +/- 10 mL (P < 0.01). Peak airway pressure in the simulated unobstructed airway was 15 +/- 2 cm H(2)O using the flow-limited bag-valve device versus 22 +/- 4 cm H(2)O using the standard bag-valve device (P < 0.01); in the simulated medium obstructed airway it was 22 +/- 1 versus 39 +/- 7 cm H(2)O (P < 0.01), and in the simulated severely obstructed airway it was 26 +/- 1 versus 61 +/- 3 cm H(2)O (P < 0.01). Stomach inflation in the simulated unobstructed airway was 0 mL/min using both bag-valve devices; in the simulated medium obstructed airway it was 0 mL/min for the flow-limited bag-valve device versus 200 +/- 20 mL/min for the standard bag-valve device (P < 0.01), and in the simulated severely obstructed airway it was 0 versus 1240 +/- 50 mL/min (P < 0.01).

CONCLUSION

In a simulated severely obstructed unprotected airway, the use of a flow-limited bag-valve device resulted in longer inspiratory times, higher tidal volumes, lower inspiratory pressures, and no stomach inflation compared with a standard bag-valve device.

背景

Smart Bag MO(R)是一种成人流量限制型袋阀装置，旨在降低未受保护气道发生胃胀气的风险。其在严重气道阻塞情况下的性能尚不清楚。

方法

在一个实验台模型中，我们评估了呼吸力学并在气道阻力为4、10和20 cm H₂O·L⁻¹·s⁻¹时通过流量限制型袋阀装置和标准袋阀装置各进行一次通气，以模拟气道未受保护的呼吸骤停患者，从而输送潮气量。

结果

流量限制型袋阀装置的吸气时间总是比标准袋阀装置长。在模拟的通畅气道中，使用流量限制型袋阀装置时肺潮气量为750±70 mL，而使用标准袋阀装置时为780±30 mL（无显著差异）；在模拟的中度阻塞气道中，分别为800±70 mL和850±20 mL（无显著差异），在模拟的严重阻塞气道中，分别为210±20 mL和170±10 mL（P<0.01）。在模拟的通畅气道中，使用流量限制型袋阀装置时气道峰值压力为15±2 cm H₂O，而使用标准袋阀装置时为22±4 cm H₂O（P<0.01）；在模拟的中度阻塞气道中，分别为22±1 cm H₂O和39±7 cm H₂O（P<0.01），在模拟的严重阻塞气道中，分别为26±1 cm H₂O和61±3 cm H₂O（P<0.01）。在模拟的通畅气道中，两种袋阀装置的胃胀气均为0 mL/min；在模拟的中度阻塞气道中，流量限制型袋阀装置的胃胀气为0 mL/min，而标准袋阀装置为200±20 mL/min（P<0.01），在模拟的严重阻塞气道中，分别为0 mL/min和1240±50 mL/min（P<0.01）。