Sancar Nurcan Kızılcık, Özcan Perihan Ergin, Şentürk Evren, Selek Çiğdem, Çakar Nahit
Department of Anaesthesiology and Reanimation, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
Turk J Anaesthesiol Reanim. 2014 Aug;42(4):170-5. doi: 10.5152/TJAR.2014.61687. Epub 2014 May 29.
The purpose of our study is to compare two different ventilation modes-pressure support ventilation (PSV) and volume support ventilation (VSV)-as the means of weaning.
Sixty patients were enrolled in our study. Patients were randomized in to two groups. For the PSV group, FiO2 and airway pressure values were adjusted in order to sustain PaCO2: 35-45 mm Hg, pH>7.32, 6-8 mL kg(-1) TV (tidal volume), and saturation >92%. For the VSV group, FiO2, TV, respiration frequency (f), and peak pressure were adjusted to obtain PaCO2: 35-45 mm Hg, pH>7.32, 6-8 mL kg(-1) TV, saturation >92%, and PO2>60 mm Hg. Every morning, spontaneous breathing was tried in those patients. The patients were extubated after 2 hours of T-piece breathing. The patients who failed spontaneous respiration with the T-piece were returned to mechanical ventilation. Assisted ventilation time (ART), mechanical ventilation time (MRT), total T-piece time (TTT), total weaning time (TWT), and sedation need (SN) values were recorded. "T-test" and "Chi-square" methods were used for statistical analysis.
In our study, the mean ART was 82.60 hours for the PSV group and 56.03 hours for the VSV group (p<0.041). TWT was 93.30 hours for the PSV group and 56.03 hours for the VSV group (p<0.035). The mean TTT was 7.67 hours for the PSV group and 3.83 hours for the VSV group (p<0.007). Nineteen patients in the PSV group and 9 patients in the VSV group required sedation during the weaning process (p<0.01).
In the weaning period, VSV seems to be more advantageous than PSV.
我们研究的目的是比较两种不同的通气模式——压力支持通气(PSV)和容量支持通气(VSV)——作为撤机手段的效果。
60例患者纳入我们的研究。患者被随机分为两组。对于PSV组,调整FiO2和气道压力值以维持PaCO2:35 - 45 mmHg,pH>7.32,潮气量(TV)为6 - 8 mL·kg⁻¹,饱和度>92%。对于VSV组,调整FiO2、TV、呼吸频率(f)和峰值压力以获得PaCO2:35 - 45 mmHg,pH>7.32,TV为6 - 8 mL·kg⁻¹,饱和度>92%,以及PO2>60 mmHg。每天早晨,对这些患者进行自主呼吸试验。患者在采用T型管呼吸2小时后拔管。对无法通过T型管实现自主呼吸的患者恢复机械通气。记录辅助通气时间(ART)、机械通气时间(MRT)、总T型管时间(TTT)、总撤机时间(TWT)和镇静需求(SN)值。采用“t检验”和“卡方检验”方法进行统计分析。
在我们的研究中,PSV组的平均ART为82.60小时,VSV组为56.03小时(p<0.041)。PSV组的TWT为93.30小时,VSV组为56.03小时(p<0.035)。PSV组的平均TTT为7.67小时,VSV组为3.83小时(p<0.007)。PSV组有19例患者和VSV组有9例患者在撤机过程中需要镇静(p<0.01)。
在撤机期间,VSV似乎比PSV更具优势。