持续充气与逐步 PEEP 策略对早产羔羊出生时气体交换和肺力学的影响。
Effect of sustained inflation vs. stepwise PEEP strategy at birth on gas exchange and lung mechanics in preterm lambs.
机构信息
1] Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia [2] Department of Neonatology, The Royal Children's Hospital, Parkville, Australia [3] Neonatal Research, The Royal Women's Hospital, Parkville, Australia [4] Department of Paediatrics, University of Melbourne, Melbourne, Australia.
1] Neonatal Research, Murdoch Childrens Research Institute, Parkville, Australia [2] Neonatal Research, The Royal Women's Hospital, Parkville, Australia [3] Department of Paediatrics, University of Melbourne, Melbourne, Australia.
出版信息
Pediatr Res. 2014 Feb;75(2):288-94. doi: 10.1038/pr.2013.218. Epub 2013 Nov 20.
BACKGROUND
Sustained inflation (SI) at birth facilitates establishment of functional residual capacity (FRC) in the preterm lung, but the ideal lung recruitment strategy is unclear. We have compared the effect of SI and a stepwise positive end-expiratory pressure (PEEP; SEP) strategy in a preterm model.
METHODS
127 d gestation lambs received either 20-s SI (n = 9) or 2 cmH2O stepwise PEEP increases to 20 cmH2O every 10 inflations, and then decreases to 6 cmH2O (n = 10). Ventilation continued for 70 min, with surfactant administered at 10 min. Alveolar-arterial oxygen gradient (AaDO2), compliance (C(dyn)), end-expiratory thoracic volume (EEVRIP; respiratory inductive plethysmography), and EEV and C(dyn) in the gravity-dependent and nondependent hemithoraces (electrical impedance tomography) were measured throughout. Early mRNA markers of lung injury were analyzed using quantitative real-time PCR.
RESULTS
From 15 min of life, AaDO2 was lower in SEP group (P < 0.005; two-way ANOVA). SEP resulted in higher and more homogeneous C(dyn) (P < 0.0001). Mean (SD) EEVRIP at 5 min was 18 (9) ml/kg and 6 (5) ml/kg following SEP and SI, respectively (P = 0.021; Bonferroni posttest); this difference was due to a greater nondependent hemithorax EEV. There was no difference in markers of lung injury.
CONCLUSION
An SEP at birth improved gas exchange, lung mechanics, and EEV, without increasing lung injury, compared to the SI strategy used.
背景
出生时持续充气（SI）有助于早产儿肺功能残气量（FRC）的建立，但理想的肺复张策略尚不清楚。我们比较了 SI 和逐步递增呼气末正压（PEEP；SEP）策略在早产儿模型中的效果。
方法
127 天胎龄的羔羊接受 20 秒 SI（n = 9）或 2 cmH2O 逐步 PEEP 增加至每 10 次充气增加 20 cmH2O，然后降至 6 cmH2O（n = 10）。通气持续 70 分钟，在 10 分钟时给予表面活性剂。在整个过程中测量肺泡-动脉氧梯度（AaDO2）、顺应性（C(dyn))、呼气末胸廓内体积（EEVRIP；呼吸感应体容积描记术）以及重力依赖性和非依赖性半胸的 EEV 和 C(dyn)（电阻抗断层扫描）。使用定量实时 PCR 分析早期肺损伤的 mRNA 标志物。
结果
从生命的 15 分钟开始，SEP 组的 AaDO2 较低（P < 0.005；双向方差分析）。SEP 导致更高且更均匀的 C(dyn)（P < 0.0001）。5 分钟时的平均（SD）EEVRIP 分别为 SEP 和 SI 后的 18（9）ml/kg 和 6（5）ml/kg（P = 0.021；Bonferroni 后检验）；这种差异是由于非依赖性半胸 EEV 更大。肺损伤标志物无差异。
结论
与 SI 策略相比，出生时使用 SEP 可改善气体交换、肺力学和 EEV，而不会增加肺损伤。
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