Reper P, Heijmans W
Critical Care Department, Queen Astrid Hospital and Free University of Brussels, Brussels, Belgium.
Critical Care Department, Queen Astrid Hospital and Free University of Brussels, Brussels, Belgium.
Burns. 2015 Feb;41(1):65-70. doi: 10.1016/j.burns.2014.05.007. Epub 2014 Jun 28.
Several biological markers of lung injury are predictors of morbidity and mortality in patients with acute respiratory distress syndrome (ARDS). Some lung-protective ventilation strategies, such as low tidal volume, are associated with a significant decrease in plasma biomarker levels compared to the high tidal volume ventilation strategy. The primary objective of this study was to test whether the institution of high-frequency percussive ventilation (HFPV) to patients with respiratory distress after smoke inhalation injury influenced initial biomarker levels of lung injury (just before and after using percussive ventilation).
A prospective observational cohort study was conducted in the intensive care unit of the Brussels Burn Center. Fifteen intubated, mechanically ventilated patients with minor burns and ARDS following smoke inhalation were enrolled in our study. Physiologic data and serum samples were collected before intubation and at four different time points within the first 48h after intubation to measure the concentration of interleukin (IL)-6, IL-8, and tumor necrosis factor-α (TNF alpha). The differences in biomarker levels before and after starting HFPV were analyzed using repeated measure analysis of variance and a paired t test with correction for multiple comparisons.
Before starting HFPV under endotracheal intubation, all biological markers (IL-6, IL-8, and TNF alpha) were elevated in the spontaneously breathing patients with acute lung injury (ALI). After intubation and institution of a positive pressure ventilation with HFPV (tidal volume 5.6-6.6ml/kg per ideal body weight), none of the biological markers were increased significantly at either an early (3±2h) or a later point in time. However, the levels of IL-8 had decreased significantly after intubation at a later point in time. During the post-intubation period, the PaO2/FiO2 (partial pressure of arterial oxygen/fraction of the inspired oxygen) ratio increased significantly and the plateau airway pressure decreased significantly.
Levels of IL-6, IL-8, and TNF alpha are elevated in spontaneously ventilating patients with minor burns and ARDS following smoke exposition prior to endotracheal intubation. The institution of HFPV with percussive positive pressure ventilation enhances blood oxygenation and could not further increase the initial levels of these biological markers of lung injury after smoke inhalation injury.
几种肺损伤生物标志物可预测急性呼吸窘迫综合征（ARDS）患者的发病率和死亡率。与高潮气量通气策略相比，一些肺保护性通气策略，如低潮气量，与血浆生物标志物水平显著降低有关。本研究的主要目的是测试对烟雾吸入性损伤后出现呼吸窘迫的患者实施高频震荡通气（HFPV）是否会影响肺损伤的初始生物标志物水平（在使用震荡通气之前和之后）。
在布鲁塞尔烧伤中心重症监护病房进行了一项前瞻性观察队列研究。15例因烟雾吸入导致轻度烧伤并患有ARDS且已插管并接受机械通气的患者纳入本研究。在插管前以及插管后48小时内的四个不同时间点收集生理数据和血清样本，以测量白细胞介素（IL）-6、IL-8和肿瘤坏死因子-α（TNF-α）的浓度。使用重复测量方差分析和校正多重比较的配对t检验分析开始HFPV前后生物标志物水平的差异。
在气管插管下开始HFPV之前，急性肺损伤（ALI）的自主呼吸患者中所有生物标志物（IL-6、IL-8和TNF-α）均升高。插管并采用HFPV进行正压通气后（潮气量为每理想体重5.6 - 6.6ml/kg），在早期（3±2小时）或后期，生物标志物均未显著增加。然而，后期插管后IL-8水平显著下降。在插管后期间，动脉血氧分压/吸入氧分数（PaO2/FiO2）比值显著升高，平台气道压力显著降低。
在气管插管前，烟雾暴露后轻度烧伤并患有ARDS的自主通气患者中IL-6、IL-8和TNF-α水平升高。采用震荡正压通气的HFPV可增强血液氧合，且不会进一步增加烟雾吸入性损伤后这些肺损伤生物标志物的初始水平。
