Hough Judith L, Shearman Andrew D, Liley Helen, Grant Caroline A, Schibler Andreas
Critical Care of the Newborn Program, Mater Research, Brisbane, Queensland, Australia; School of Physiotherapy, Australian Catholic University, Brisbane, Queensland, Australia; Paediatric Critical Care Research Group, Paediatric Intensive Care Unit, Mater Children's Hospital, Brisbane, Queensland, Australia.
J Paediatr Child Health. 2014 Nov;50(11):884-9. doi: 10.1111/jpc.12661. Epub 2014 Jun 26.
Although suctioning is a standard airway maintenance procedure, there are significant associated risks, such as loss of lung volume due to high negative suction pressures. This study aims to assess the extent and duration of change in end-expiratory level (EEL) resulting from endotracheal tube (ETT) suction and to examine the relationship between EEL and regional lung ventilation in ventilated preterm infants with respiratory distress syndrome.
A prospective observational clinical study of the effect of ETT suction on 20 non-muscle-relaxed preterm infants with respiratory distress syndrome (RDS) on conventional mechanical ventilation was conducted in a neonatal intensive care unit. Ventilation distribution was measured with regional impedance amplitudes and EEL using electrical impedance tomography.
ETT suction resulted in a significant increase in EEL post-suction (P < 0.01). Regionally, anterior EEL decreased and posterior EEL increased post-suction, suggesting heterogeneity. Tidal volume was significantly lower in volume-guarantee ventilation compared with pressure-controlled ventilation (P = 0.04).
ETT suction in non-muscle-relaxed and ventilated preterm infants with RDS results in significant lung volume increase that is maintained for at least 90 min. Regional differences in distribution of ventilation with ETT suction suggest that the behaviour of the lung is heterogeneous in nature.
尽管吸痰是一种标准的气道维护操作，但存在显著的相关风险，如因高负压吸引导致肺容量损失。本研究旨在评估气管内插管（ETT）吸痰引起的呼气末水平（EEL）变化的程度和持续时间，并探讨EEL与患有呼吸窘迫综合征的机械通气早产儿区域肺通气之间的关系。
在新生儿重症监护病房对20例接受常规机械通气、未使用肌肉松弛剂的患有呼吸窘迫综合征（RDS）的早产儿进行了一项关于ETT吸痰效果的前瞻性观察性临床研究。使用电阻抗断层扫描通过区域阻抗幅度和EEL测量通气分布。
ETT吸痰导致吸痰后EEL显著增加（P < 0.01）。在区域上，吸痰后前侧EEL降低，后侧EEL增加，提示存在异质性。与压力控制通气相比，容量保证通气时潮气量显著更低（P = 0.04）。
对未使用肌肉松弛剂且接受机械通气的患有RDS的早产儿进行ETT吸痰会导致肺容量显著增加，且至少维持90分钟。ETT吸痰时通气分布的区域差异表明肺的行为本质上是异质性的。
