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科洛博气管导管减少无效腔并不能成为在小容量通气肺中放弃容量监测的理由。

Dead space reduction by Kolobow's endotracheal tube does not justify the waiving of volume monitoring in small, ventilated lungs.

作者信息

Proquitté Hans, Wendel Rena, Roehr Charles C, Wauer Roland R, Schmalisch Gerd

机构信息

Department of Neonatology, Charité University Medical Center, Charitéplatz 1, 10117, Berlin, Germany.

出版信息

J Clin Monit Comput. 2014 Dec;28(6):605-11. doi: 10.1007/s10877-014-9559-5. Epub 2014 Jan 28.

Abstract

In ventilated preterm infants the flow sensor contributes significantly to the total apparatus dead space, which may impair gas exchange. The aim of the study was to quantify to which extent a dead space reduced Kolobow tube (KB) without flow sensor improves the gas exchange compared with a conventional ventilator circuit with flow sensor [Babylog 8000 (BL)]. In a cross-over trial in 14 tracheotomized, surfactant-depleted (saline lavage) and mechanically ventilated newborn piglets (age <12 h; body weight 705-1200 g) BL and KB was applied alternately for 15 min and blood gases were recorded. The inner diameter of the endotracheal tube was 3.6 mm and the apparatus dead space of BL and KB including the endotracheal tube were 3.0 and 1.34 mL. Despite a 50 % apparatus dead space reduction with KB compared to BL statistically significant improvements were only observed for body weights <900 g. In this weight group median paCO2 was decreased by 5 mmHg (p < 0.01), whereas the improvement decreased with decreasing baseline paCO2. Furthermore, median paO2 was increased by 4 mmHg (p < 0.05) and O2 saturation was increased by 2.5 % (p < 0.05). No significant changes were seen in the circulatory parameters. In very small, ventilated lungs the use of KB improved the gas exchange; however, the improvement was moderate and does not justify the waiving of volume monitoring.

摘要

在机械通气的早产儿中,流量传感器对整个设备死腔有显著影响,这可能会损害气体交换。本研究的目的是量化与带有流量传感器的传统通气回路[Babylog 8000(BL)]相比,无流量传感器的死腔减少型Kolobow管(KB)在多大程度上能改善气体交换。在一项交叉试验中,对14只气管切开、表面活性剂耗竭(盐水灌洗)且机械通气的新生仔猪(年龄<12小时;体重705 - 1200克)交替应用BL和KB,每次15分钟,并记录血气。气管内导管的内径为3.6毫米,BL和KB包括气管内导管的设备死腔分别为3.0毫升和1.34毫升。尽管与BL相比,KB使设备死腔减少了50%,但仅在体重<900克的仔猪中观察到了具有统计学意义的改善。在这个体重组中,动脉血二氧化碳分压(paCO2)中位数降低了5毫米汞柱(p < 0.01),而这种改善随着基线paCO2的降低而减小。此外,动脉血氧分压(paO2)中位数增加了4毫米汞柱(p < 0.05),血氧饱和度增加了2.5%(p < 0.05)。循环参数未见显著变化 在非常小的机械通气肺中,使用KB改善了气体交换;然而,这种改善是适度的,并不足以证明可以放弃容量监测。

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