Soroksky Arie, Kheifets Julia, Girsh Solomonovich Zehava, Tayem Emad, Gingy Ronen Balmor, Rozhavsky Boris
Intensive Care Unit, E. Wolfson Medical Center, 62 HaLohamim Street, P.O. Box 5, 58100 Holon, Israel ; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Biomed Res Int. 2015;2015:385042. doi: 10.1155/2015/385042. Epub 2015 Jan 28.
Patients with severe acute respiratory distress syndrome (ARDS) and hypercapnia present a formidable treatment challenge. We examined the use of esophageal balloon for assessment of transpulmonary pressures to guide mechanical ventilation for successful management of severe hypercapnia.
Patients with severe ARDS and hypercapnia were studied. Esophageal balloon was inserted and mechanical ventilation was guided by assessment of transpulmonary pressures. Positive end expiratory pressure (PEEP) and inspiratory driving pressures were adjusted with the aim of achieving tidal volume of 6 to 8 mL/kg based on ideal body weight (IBW), while not exceeding end inspiratory transpulmonary (EITP) pressure of 25 cm H2O.
Six patients with severe ARDS and hypercapnia were studied. Mean PaCO2 on enrollment was 108.33 ± 25.65 mmHg. One hour after adjustment of PEEP and inspiratory driving pressure guided by transpulmonary pressure, PaCO2 decreased to 64.5 ± 16.89 mmHg (P < 0.01). Tidal volume was 3.96 ± 0.92 mL/kg IBW before and increased to 7.07 ± 1.21 mL/kg IBW after intervention (P < 0.01). EITP pressure before intervention was low with a mean of 13.68 ± 8.69 cm H2O and remained low at 16.76 ± 4.76 cm H2O (P = 0.18) after intervention. Adjustment of PEEP and inspiratory driving pressures did not worsen oxygenation and did not affect cardiac output significantly.
The use of esophageal balloon as a guide to mechanical ventilation was able to treat severe hypercapnia in ARDS patients.
患有严重急性呼吸窘迫综合征（ARDS）和高碳酸血症的患者面临着严峻的治疗挑战。我们研究了使用食管球囊评估跨肺压以指导机械通气，从而成功管理严重高碳酸血症的情况。
对患有严重ARDS和高碳酸血症的患者进行研究。插入食管球囊，并通过评估跨肺压来指导机械通气。调整呼气末正压（PEEP）和吸气驱动压力，目标是基于理想体重（IBW）实现6至8 mL/kg的潮气量，同时不超过25 cm H2O的吸气末跨肺（EITP）压力。
对6例患有严重ARDS和高碳酸血症的患者进行了研究。入组时平均动脉血二氧化碳分压（PaCO2）为108.33±25.65 mmHg。在跨肺压指导下调整PEEP和吸气驱动压力1小时后，PaCO2降至64.5±16.89 mmHg（P<0.01）。干预前潮气量为3.96±0.92 mL/kg IBW，干预后增加至7.07±1.21 mL/kg IBW（P<0.01）。干预前EITP压力较低，平均为13.68±8.69 cm H2O，干预后仍较低，为16.76±4.76 cm H2O（P = 0.18）。调整PEEP和吸气驱动压力并未使氧合恶化，也未显著影响心输出量。
使用食管球囊作为机械通气的指导能够治疗ARDS患者的严重高碳酸血症。
