Anan'ev E P, Polupan A A, Matskovskiy I V, Oshorov A V, Goryachev A S, Savin I A, Sychev A A, Tabasaranskiy T F, Podlepich V V, Krylov K Yu, Pashin A A, Satishur O E, Piquilloud L, Novotni D, Potapov A A, Savchenko Ya V
Burdenko Neurosurgical Institute, Moscow, Russia.
Emergency Hospital of Minsk, Minsk, Belarus.
Zh Vopr Neirokhir Im N N Burdenko. 2017;81(5):63-68. doi: 10.17116/neiro201781563-68.
the study purpose was to evaluate the efficacy of the IntelliVent-ASV mode in maintaining the target range of PaCO2 in patients with severe TBI.
The study included 12 severe TBI patients with the wakefulness level scored 4-9 (GCS). This was a crossover design study. Two ventilation modes were consecutively used: IntelliVent-ASV and P-CMV, for 12 h each. When using the P-CMV mode, the ventilation parameters were set to maintain PaCO2 in a range of 35-38 mm Hg. The IntelliVent-ASV mode involved the Brain Injury ventilation algorithm. The target range of EtCO2 was set in accordance with the delta PaCO2-EtCO2 to maintain PaCO2 in a range of 35-38. At the beginning of each ventilation period and every 3 hours, the arterial blood gas composition was analyzed. When PaCO2 occurred out of the 35-38 range, appropriate adjustments were made to the ventilation parameters. In the P-CMV mode, the Pinsp and RR parameters were adjusted to achieve the target PaCO2 range. In IntelliVent mode, a shift of the target EtCO2 range was adjusted in accordance with a changed PaCO2-EtCO2 difference. In all patients, ICP, blood pressure, and EtCO2 were monitored; the arterial blood gas composition was analyzed every 3 h; the frequency of manual settings of ventilation parameters was recorded.
The EtCO2 and PaCO2 parameters were found not to be significantly different in the P-CMV and IntelliVent modes, but the spread in these parameters was significantly lower in the IntelliVent ventilation mode. The PaCO2 parameter occurred out of the target range significantly less often in the IntelliVent mode than in the P-CMV mode. The mean frequency of manual respirator settings needed to maintain the target EtCO2 range was significantly lower in the IntelliVent-ASV mode than in the P-CMV mode.
The IntelliVent-ASV mode provides more efficient maintenance of PaCO2 in the target range compared to traditional artificial ventilation using fewer manual settings of the ventilation parameters.
本研究旨在评估智能通气 - 自适应支持通气（IntelliVent - ASV）模式在维持重度创伤性脑损伤（TBI）患者动脉血二氧化碳分压（PaCO2）目标范围内的疗效。
本研究纳入12例清醒程度评分为4 - 9分（格拉斯哥昏迷量表[GCS]）的重度TBI患者。这是一项交叉设计研究。连续使用两种通气模式：IntelliVent - ASV和压力控制 - 容量控制通气（P - CMV），每种模式各持续12小时。使用P - CMV模式时，将通气参数设置为使PaCO2维持在35 - 38毫米汞柱范围内。IntelliVent - ASV模式采用脑损伤通气算法。根据动脉血二氧化碳分压与呼气末二氧化碳分压（EtCO2）差值（ΔPaCO2 - EtCO2）设置EtCO2目标范围，以维持PaCO2在35 - 38范围内。在每个通气周期开始时及每3小时，分析动脉血气成分。当PaCO2超出35 - 38范围时，对通气参数进行适当调整。在P - CMV模式下，调整吸气压力（Pinsp）和呼吸频率（RR）参数以达到目标PaCO2范围。在IntelliVent模式下，根据变化的ΔPaCO2 - EtCO2差值调整目标EtCO2范围。对所有患者监测颅内压（ICP）、血压和EtCO2；每3小时分析动脉血气成分；记录通气参数手动设置的频率。
发现P - CMV模式和IntelliVent模式下的EtCO2和PaCO2参数无显著差异，但IntelliVent通气模式下这些参数的离散度显著更低。IntelliVent模式下PaCO2参数超出目标范围的情况明显少于P - CMV模式。与P - CMV模式相比，IntelliVent - ASV模式维持目标EtCO2范围所需的呼吸机手动设置平均频率显著更低。
与传统人工通气相比，IntelliVent - ASV模式能更有效地将PaCO2维持在目标范围内，且通气参数的手动设置更少。
