Lain D C, DiBenedetto R, Morris S L, Van Nguyen A, Saulters R, Causey D
Memorial Medical Center, Department of Respiratory Care, Savannah, GA 31403.
Chest. 1989 May;95(5):1081-8. doi: 10.1378/chest.95.5.1081.
Nineteen patients with ARDS or pneumonia who were ventilated with PcIRV on the Siemens-Elema Servo 900 C were retrospectively reviewed. The PcIRV reduced peak airway pressure, PEEP, increased Paw, and improved ventilation and oxygenation in these patients. When these patients were compared with themselves on prior conventional IPPV, all had a decrease in PIP, an increase in Paw and most had a decrease in VE, with no change in PaCO2 and an increase in PaO2. The increase in Paw may have contributed to this improved arterial oxygenation. High levels of PIP and PEEP during IPPV have been identified as risk factors in the development of barotrauma and residual parenchymal pulmonary damage. We propose that PcIRV allows for adequate ventilation and oxygenation with decreases in PIP, extrinsically added PEEP and inspired O2 concentration. This mode of ventilation may decrease the morbidity associated with IPPV utilizing high PIP and PEEP.
回顾性分析了19例使用西门子-埃勒玛Servo 900 C呼吸机进行压力控制反比通气（PcIRV）的急性呼吸窘迫综合征（ARDS）或肺炎患者。PcIRV降低了气道峰压、呼气末正压（PEEP），增加了平均气道压（Paw），并改善了这些患者的通气和氧合。当将这些患者与之前接受传统间歇正压通气（IPPV）时的自身情况进行比较时，所有患者的气道峰压（PIP）均降低，Paw升高，且大多数患者的每分钟通气量（VE）降低，动脉血二氧化碳分压（PaCO2）无变化，动脉血氧分压（PaO2）升高。Paw的升高可能有助于改善动脉氧合。IPPV期间高水平的PIP和PEEP已被确定为气压伤和残余实质性肺损伤发生的危险因素。我们认为，PcIRV可在降低PIP、外部附加PEEP和吸入氧浓度的情况下实现充分的通气和氧合。这种通气模式可能会降低与使用高PIP和PEEP的IPPV相关的发病率。
