使用氧气吹入法进行呼吸暂停测试以诊断脑死亡可能会损害肺功能。

Apnea testing using the oxygen insufflation method for diagnosis of brain death may compromise pulmonary function.

作者信息

Sołek-Pastuszka Joanna, Sawicki Marcin, Iwańczuk Waldemar, Kojder Klaudyna, Saucha Wojciech, Czajkowski Zenon, Chełstowski Kornel, Bohatyrewicz Romuald

机构信息

Department of Anaesthesiology and Intensive Care, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1 Street, 71-252 Szczecin, Poland.

Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1 Street, 71-252 Szczecin, Poland.

出版信息

J Crit Care. 2018 Apr;44:175-178. doi: 10.1016/j.jcrc.2017.10.038. Epub 2017 Oct 28.

DOI:10.1016/j.jcrc.2017.10.038

PMID:29128780

Abstract

INTRODUCTION

The aim of our study was to compare the reliability and safety of the classical I-AT with the continuous positive airway pressure apnea test (CPAP-AT).

MATERIAL AND METHODS

In the group of 48 patients (group O), an I-AT was performed at the end of BD diagnostic procedures, and approximately 1-1.5h later CPAP-AT with 100% FiO and CPAP of 10cm HO, provided by ventilator in CPAP mode. After pre‑oxygenation with 100% FiO for 10min, the PaO/FiO ratio was recorded prior to I-AT at time-point one (T1) and prior to CPAP-AT at time-point two (T2). Group O was categorized into subgroup N-H (non-hypoxemic), consisting of 41 patients with good lung function, and subgroup H (hypoxemic) consisting of 7 patients with poor lung function. Within each subgroup PaO/FiO at T1 and T2 were compared.

RESULTS

In Group O, PaO/FiO decreased from 321±128mmHg at T1 to 291±119mmHg at T2 (p=0.004). In subgroup N-H, PaO/FiO declined from 355±103 to 321±100mmHg (p=0.008), and in subgroup H, PaO/FiO remained almost unchanged. Additionally, in 4 patients from subgroup N-H, PaO/FiO decreased below 200mmHg at T2.

CONCLUSIONS

Our study indicates that I-AT may compromise pulmonary function and this may support the recommendation of safer CPAP-AT alternative.

摘要

引言

我们研究的目的是比较经典的间歇性气道闭塞试验（I-AT）与持续气道正压通气呼吸暂停试验（CPAP-AT）的可靠性和安全性。

材料与方法

在48例患者组（O组）中，在支气管镜诊断程序结束时进行I-AT，约1-1.5小时后，通过呼吸机以CPAP模式提供100%氧浓度和10cmH₂O的CPAP进行CPAP-AT。在以100%氧浓度预充氧10分钟后，在时间点一（T1）I-AT前和时间点二（T2）CPAP-AT前记录动脉血氧分压/吸氧浓度（PaO₂/FiO₂）比值。O组分为非低氧血症亚组（N-H，41例肺功能良好患者）和低氧血症亚组（H，7例肺功能较差患者）。比较每个亚组在T1和T2时的PaO₂/FiO₂。

结果

在O组中，PaO₂/FiO₂从T1时的321±128mmHg降至T2时的291±119mmHg（p=0.004）。在N-H亚组中，PaO₂/FiO₂从355±103降至321±100mmHg（p=0.008），而在H亚组中，PaO₂/FiO₂几乎保持不变。此外，在N-H亚组的4例患者中，T2时PaO₂/FiO₂降至200mmHg以下。