Briones-Claudett Killen Harold, Esquinas Rodriguez Antonio, Briones-Claudett Mónica H, Puga-Tejada Miguel, Cabrera Baños Mariuxi Del Pilar, Pazmiño Dueñas Christian Roberto, Torres Herrera Carlos Israel, Grunauer Michelle
Universidad de Guayaquil. Facultad de Ciencias Médicas. Guayaquil, Ecuador, Ecuador; Intensive Care Unit, Ecuadorian Institute of Social Security (IESS), Babahoyo, Ecuador; Centro Fisiológico-Respiratorio Briones-Claudett, Guayaquil, Ecuador.
Anaesthesiol Intensive Ther. 2018;50(4):283-290. doi: 10.5603/AIT.a2018.0036. Epub 2018 Oct 14.
This study was designed to determine the results associated with the use of noninvasive mechanical ventilation (NIV) using the BiPAP S/T-AVAPS ventilation strategy in subjects with mild to moderate de novohypoxaemicrespiratory failure.
This is a prospective study that includes subjects with de novohypoxaemic respiratory failure (not produced by acute exacerbations of COPD, chronic lung disease, or congestive heart failure) with mild to moderate PaO₂/FiO₂, who were admitted to the Intensive Care Unit (ICU) of Santa Maria Clinic in Guayaquil, Ecuador. Subjects were divided into two groups and compared according to their PaO₂/FiO₂: higher than 100 and up to 200 mm Hg (moderate ARDS) or between 200 and 300 mm Hg (mild ARDS) (both groups were ventilated with the BiPAP S/T-AVAPS strategy). A value of P < 0.05 was considered significant.
A total of 38 subjects were analysed in this study. The total rate of intubation was 34.2% while the mortality rate was 28.9%. Significant differences were observed when comparing success versus failure in exhaled tidal volumes (P = 0.04), peak inspired pressure (P < 0.001), PaO₂ (P < 0.001), SaO₂ (P < 0.002), PaO₂/FiO₂ (P < 0.002), RR (P < 0.001), HR (P < 0.001), and inspiratory time (P = 0.029) measured at baseline and at 12-hour, 24-hour and 48-hour intervals.
The BiPAP S/T-AVAPS ventilatory mode can be used in subjects with de novo hypoxaemic respiratory failure with special vigilance concerning exhaled tidal volumes and inspired pressure.
本研究旨在确定在轻度至中度新发低氧血症性呼吸衰竭患者中使用双水平气道正压通气（BiPAP）S/T-自适应通气辅助压力支持（AVAPS）通气策略进行无创机械通气（NIV）的相关结果。
这是一项前瞻性研究，纳入了厄瓜多尔瓜亚基尔圣玛丽亚诊所重症监护病房（ICU）收治的轻度至中度PaO₂/FiO₂的新发低氧血症性呼吸衰竭患者（非由慢性阻塞性肺疾病、慢性肺部疾病或充血性心力衰竭急性加重所致）。根据患者的PaO₂/FiO₂将其分为两组并进行比较：高于100至200 mmHg（中度急性呼吸窘迫综合征）或200至300 mmHg（轻度急性呼吸窘迫综合征）（两组均采用BiPAP S/T-AVAPS策略通气）。P<0.05的值被认为具有统计学意义。
本研究共分析了38例患者。总插管率为34.2%，死亡率为28.9%。在比较基线时以及12小时、24小时和48小时间隔测量的呼出潮气量（P = 0.04）、吸气峰压（P < 0.001）、PaO₂（P < 0.001）、SaO₂（P < 0.002）、PaO₂/FiO₂（P < 0.002）、呼吸频率（RR）（P < 0.001）、心率（HR）（P < 0.001）和吸气时间（P = 0.029）的成功与失败情况时，观察到显著差异。
BiPAP S/T-AVAPS通气模式可用于新发低氧血症性呼吸衰竭患者，但需特别关注呼出潮气量和吸气压力。
