Department of Anesthesiology and Intensive Care Therapy, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Dresden, Germany.
Crit Care Med. 2011 Apr;39(4):746-55. doi: 10.1097/CCM.0b013e318206bda6.
To explore whether 1) conventional pressure support ventilation improves lung function and attenuates the pulmonary inflammatory response compared to pressure-controlled ventilation and 2) random variation of pressure support levels (noisy pressure support ventilation) adds further beneficial effects to pressure support ventilation.
Three-arm, randomized, experimental study.
University hospital research facility.
Twenty-four juvenile pigs.
Acute lung injury was induced by surfactant depletion. Animals were randomly assigned to 6 hrs of mechanical ventilation (n = 8 per group) with either 1) pressure-controlled ventilation, 2) pressure support ventilation, or 3) noisy pressure support ventilation. During noisy pressure support ventilation, the pressure support varied randomly, with values following a normal distribution. In all groups, the driving pressures were set to achieve a mean tidal volume of 6 mL/kg. At the end of experiments, animals were killed and lungs extracted for histologic and biochemical analysis.
Respiratory, gas-exchange, and hemodynamics variables were assessed hourly. The diffuse alveolar damage and the inflammatory response of lungs were quantified. Pressure support ventilation and noisy pressure support ventilation improved gas exchange and were associated with reduced histologic damage and interleukin-6 concentrations in lung tissue compared to pressure-controlled ventilation. Noisy pressure support ventilation further improved gas exchange and decreased the inspiratory effort while reducing alveolar edema and inflammatory infiltration compared to pressure support ventilation.
In this model of acute lung injury, pressure support ventilation and noisy pressure support ventilation attenuated pulmonary inflammatory response and improved gas exchange as compared to pressure-controlled ventilation. Noisy pressure support ventilation further improved gas exchange, reduced the inspiratory effort, and attenuated alveolar edema and inflammatory infiltration as compared to conventional pressure support ventilation.
探讨常规压力支持通气（pressure support ventilation，PSV）与压力控制通气（pressure-controlled ventilation，PCV）相比，是否能改善肺功能并减轻肺部炎症反应；以及压力支持水平的随机变化（噪声 PSV）是否对 PSV 有进一步的有益作用。
三臂、随机、实验研究。
大学医院研究设施。
24 头幼年猪。
用表面活性剂耗竭法诱导急性肺损伤。动物被随机分配到 6 小时的机械通气（每组 8 只）：1）PCV，2）PSV，或 3）噪声 PSV。在噪声 PSV 期间，压力支持随机变化，其值遵循正态分布。在所有组中，驱动压力均设定为实现 6ml/kg 的平均潮气量。在实验结束时，处死动物并取出肺进行组织学和生化分析。
每小时评估呼吸、气体交换和血液动力学变量。量化弥漫性肺泡损伤和肺部炎症反应。与 PCV 相比，PSV 和噪声 PSV 改善了气体交换，并与组织学损伤减轻和肺组织中白细胞介素-6 浓度降低相关。与 PSV 相比，噪声 PSV 进一步改善了气体交换，降低了吸气努力，同时减少了肺泡水肿和炎症浸润。
在急性肺损伤模型中，与 PCV 相比，PSV 和噪声 PSV 减轻了肺部炎症反应并改善了气体交换。与常规 PSV 相比，噪声 PSV 进一步改善了气体交换，降低了吸气努力，减轻了肺泡水肿和炎症浸润。
