Trang T T, Tibballs J, Mercier J C, Beaufils F
Service de Reánimatation Pédiatrique, Hôpital Robert Debre, Paris, France.
Crit Care Med. 1988 Nov;16(11):1094-7. doi: 10.1097/00003246-198811000-00002.
In respiratory distress syndrome (RDS), PEEP improves arterial oxygenation but may impair cardiac output. The effects of PEEP on gas exchange and hemodynamics were studied in 12 mechanically ventilated newborns in the acute phase of RDS. Stepwise increase in PEEP resulted in both a) a progressive increase in PaO2 and transcutaneous oxyhemoglobin saturation, and b) a depression of pulsed Doppler-measured cardiac output that was statistically significant at 9 cm H2O PEEP. Thus, averaged systemic oxygen delivery (DO2) was maintained with improved arterial oxygenation up to 6 cm H2O PEEP. Further increase in PEEP induced a significant fall in DO2. No variation was observed in heart rate and mean arterial pressure. The combined use of oximetry and pulsed Doppler echocardiography enables noninvasive optimization of mechanical ventilation and PEEP during the clinical course.
在呼吸窘迫综合征（RDS）中，呼气末正压通气（PEEP）可改善动脉氧合，但可能损害心输出量。在12例处于RDS急性期的机械通气新生儿中研究了PEEP对气体交换和血流动力学的影响。逐步增加PEEP导致：a）动脉血氧分压（PaO2）和经皮氧合血红蛋白饱和度逐渐升高；b）经脉冲多普勒测量的心输出量降低，在9 cm H2O PEEP时具有统计学意义。因此，在PEEP高达6 cm H2O时，随着动脉氧合改善，平均全身氧输送（DO2）得以维持。PEEP进一步增加导致DO2显著下降。心率和平均动脉压未观察到变化。在临床过程中，脉搏血氧饱和度测定法和脉冲多普勒超声心动图联合使用能够实现机械通气和PEEP的无创优化。
