Kotani Toru, Katayama Shinshu, Fukuda Satoshi, Miyazaki Yuya, Sato Yoko
Department of Anesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan.
Springerplus. 2016 Jun 14;5(1):716. doi: 10.1186/s40064-016-2440-x. eCollection 2016.
Low tidal volume ventilation improves the outcomes of acute respiratory distress syndrome (ARDS). However, no studies have investigated the use of a rescue therapy involving mechanical ventilation when low tidal volume ventilation cannot maintain homeostasis. Inverse ratio ventilation (IRV) is one candidate for such rescue therapy, but the roles and effects of IRV as a rescue therapy remain unknown.
We undertook a retrospective review of the medical records of patients with ARDS who received IRV in our hospital from January 2007 to May 2014. Gas exchange, ventilation, and outcome data were collected and analyzed.
Pressure-controlled IRV was used for 13 patients during the study period. Volume-controlled IRV was not used. IRV was initiated on 4.4 ventilation days when gas exchange could not be maintained. IRV significantly improved the PaO2/FiO2 from 76 ± 27 to 208 ± 91 mmHg without circulatory impairment. The mean duration of IRV was 10.5 days, and all survivors were weaned from mechanical ventilation and discharged. The 90-day mortality rate was 38.5 %. Univariate analysis showed that the duration of IRV was associated with the 90-day mortality rate. No patients were diagnosed with pneumothorax.
Pressure-controlled IRV provided acceptable gas exchange without apparent complications and served as a successful bridge to conventional treatment when used as a rescue therapy for moderate to severe ARDS.
低潮气量通气可改善急性呼吸窘迫综合征（ARDS）的预后。然而，尚无研究探讨在低潮气量通气无法维持内环境稳定时使用包括机械通气在内的挽救治疗方法。反比通气（IRV）是这种挽救治疗的一种选择，但IRV作为挽救治疗的作用和效果尚不清楚。
我们对2007年1月至2014年5月在我院接受IRV治疗的ARDS患者的病历进行了回顾性研究。收集并分析气体交换、通气和预后数据。
在研究期间，13例患者使用了压力控制反比通气。未使用容量控制反比通气。在通气第4.4天，当气体交换无法维持时开始使用IRV。IRV显著改善了动脉血氧分压/吸入氧分数值（PaO2/FiO2），从76±27mmHg提高到208±91mmHg，且无循环功能障碍。IRV的平均持续时间为10.5天，所有存活患者均成功脱机并出院。90天死亡率为38.5%。单因素分析显示，IRV的持续时间与90天死亡率相关。没有患者被诊断为气胸。
压力控制反比通气可提供可接受的气体交换，且无明显并发症，作为中重度ARDS的挽救治疗时，可成功过渡到传统治疗。
