Fernandez-Restrepo Lorena, Shaffer Lauren, Amalakuhan Bravein, Restrepo Marcos I, Peters Jay, Restrepo Ruben
Lorena Fernandez-Restrepo, Lauren Shaffer, Bravein Amalakuhan, Marcos I Restrepo, Jay Peters, Ruben Restrepo, Division of Pediatric Critical Care, Division of Pulmonary and Critical Care, and Department of Respiratory Care, University of Texas Health Science Center and the South Texas Veterans Health Care System, San Antonio, TX 78240, United States.
World J Crit Care Med. 2017 Aug 4;6(3):164-171. doi: 10.5492/wjccm.v6.i3.164.
To determine the ability of intrapulmonary percussive ventilation (IPV) to promote airway clearance in spontaneously breathing patients and those on mechanical ventilation.
An artificial lung was used to simulate a spontaneously breathing patient (Group 1), and was then connected to a mechanical ventilator to simulate a patient on mechanical ventilation (Group 2). An 8.5 mm endotracheal tube (ETT) connected to the test lung, simulated the patient airway. Artificial mucus was instilled into the mid-portion of the ETT. A filter was attached at both ends of the ETT to collect the mucus displaced proximally (mouth-piece filter) and distally (lung filter). The IPV machine was attached to the proximal end of the ETT and was applied for 10-min each to Group 1 and 2. After each experiment, the weight of the various circuit components were determined and compared to their dry weights to calculate the weight of the displaced mucus.
In Group 1 (spontaneously breathing model), 26.8% ± 3.1% of the simulated mucus was displaced proximally, compared to 0% in Group 2 (the mechanically ventilated model) with a -value of < 0.01. In fact, 17% ± 1.5% of the mucus in Group 2 remained in the mid-portion of the ETT where it was initially instilled and 80% ± 4.2% was displaced distally back towards the lung ( < 0.01). There was an overall statistically significant amount of mucus movement proximally towards the mouth-piece in the spontaneously breathing (SB) patient. There was also an overall statistically significant amount of mucus movement distally back towards the lung in the mechanically ventilated (MV) model. In the mechanically ventilated model, no mucus was observed to move towards the proximal/mouth piece section of the ETT.
This bench model suggests that IPV is associated with displacement of mucus towards the proximal mouthpiece in the SB patient, and distally in the MV model.
确定肺内叩击通气（IPV）促进自主呼吸患者和机械通气患者气道清除的能力。
使用人工肺模拟自主呼吸患者（第1组），然后连接到机械通气机以模拟机械通气患者（第2组）。连接到测试肺的8.5毫米气管内导管（ETT）模拟患者气道。将人工黏液滴入ETT中部。在ETT两端连接过滤器，以收集向近端（口件过滤器）和远端（肺过滤器）移位的黏液。将IPV机器连接到ETT近端，分别应用于第1组和第2组10分钟。每次实验后，确定各种回路组件的重量，并与它们的干重进行比较，以计算移位黏液的重量。
在第1组（自主呼吸模型）中，26.8%±3.1%的模拟黏液向近端移位，而第2组（机械通气模型）为0%，P值<0.01。实际上，第2组中17%±1.5%的黏液留在最初滴入的ETT中部，80%±4.2%向远端移回肺部（P<0.01）。在自主呼吸（SB）患者中，向口件近端总体上有统计学意义的黏液移动。在机械通气（MV）模型中，也有总体上有统计学意义的黏液向肺部远端移动。在机械通气模型中，未观察到黏液向ETT的近端/口件部分移动。
该实验台模型表明，IPV与SB患者黏液向近端口件移位以及MV模型中黏液向远端移位有关。
