Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
Department of Pediatrics, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, ROC.
J Chin Med Assoc. 2019 Oct;82(10):795-801. doi: 10.1097/JCMA.0000000000000070.
Bubble continuous positive airway pressure (BCPAP) has been used in neonates with respiratory distress for decades; however, the optimal setting for BCPAP circuits remains unknown. This study compared the gas exchange efficiency and lung protection efficacy between conventional and high-amplitude BCPAP devices.
We compared gas exchange, lung volume, and pulmonary inflammation severity among rats with ventilator-induced lung injury (VILI) that were treated with conventional BCPAP (BCPAP with an expiratory limb at 0°), high-amplitude BCPAP (BCPAP with an expiratory limb at 135°), or spontaneous breathing (SB). After mechanical ventilation for 90 minutes, the rats were randomly divided into four groups: a control group (euthanized immediately; n = 3), an SB group (n = 8), and two BCPAP groups that received BCPAP with the expiratory limb at either 0° (n = 8) or 135° (n = 7) for 90 minutes.
The high-amplitude BCPAP group exhibited significantly lower alveolar protein, lung volume, and Interleukin-6 (IL-6) levels than did the SB group. The high-amplitude BCPAP group exhibited significantly lower IL-6 levels than did the conventional BCPAP group. The two BCPAP groups demonstrated no difference in gas exchange efficiency.
High-amplitude BCPAP reduced lung inflammation and alveolar overdistension in rats with VILI after mechanical ventilation was ceased. Thus high-amplitude BCPAP may offer a superior lung protective effect than conventional BCPAP.
气泡持续气道正压通气（BCPAP）已在患有呼吸窘迫的新生儿中使用了数十年；然而，BCPAP 回路的最佳设置仍不清楚。本研究比较了常规和高振幅 BCPAP 设备的气体交换效率和肺保护效果。
我们比较了呼吸机诱导性肺损伤（VILI）大鼠的气体交换、肺容积和肺炎症严重程度，这些大鼠分别接受了常规 BCPAP（呼气支为 0°的 BCPAP）、高振幅 BCPAP（呼气支为 135°的 BCPAP）或自主呼吸（SB）治疗。机械通气 90 分钟后，大鼠随机分为四组：对照组（立即安乐死；n = 3）、SB 组（n = 8）和两个 BCPAP 组，其中呼气支分别为 0°（n = 8）或 135°（n = 7）的 BCPAP 组各接受 90 分钟的治疗。
高振幅 BCPAP 组的肺泡蛋白、肺容积和白细胞介素-6（IL-6）水平明显低于 SB 组。高振幅 BCPAP 组的 IL-6 水平明显低于常规 BCPAP 组。两组 BCPAP 组的气体交换效率无差异。
机械通气停止后，高振幅 BCPAP 可降低 VILI 大鼠的肺炎症和肺泡过度膨胀。因此，高振幅 BCPAP 可能比常规 BCPAP 提供更好的肺保护效果。
