“肺开放”通气策略对急性呼吸窘迫综合征烧伤患者的影响。
Impact of "opening the lung" ventilatory strategy on burn patients with acute respiratory distress syndrome.
机构信息
National Burn Hospital, Hanoi, Viet Nam.
National Burn Hospital, Hanoi, Viet Nam.
出版信息
Burns. 2019 Dec;45(8):1841-1847. doi: 10.1016/j.burns.2019.05.016. Epub 2019 Jun 15.
OBJECTIVE
The objective of this study was to investigate the feasibility and influence of opening the lung strategy ventilation on burned patients complicated with ARDS.
METHODS
A prospective study was carried out in 66 moderate to severe burned patients also presented with ARDS who were randomly divided into the control group (ventilated as ARDS net) and the study group (ventilated with open lung strategy). All patients were ventilated with volume control mode until weaning.
RESULTS
Opening the lung procedure was safe in all patients with optimal PEEP of 14.8 ± 1.8 cmHO. After 24 h of lung recruitment and PEEP titration, oxygenation significantly improved (PaO/FiO ratio increased from 119.8 ± 7.4 to 263.4 ± 11.6; p < 0.01). Along the time, the absolute values of static compliances in the study group were significantly higher (33.9 ± 0.9 vs. 26.3 ± 0.6 at 1st day; 48.4 ± 1.5 vs. 35.7 ± 0.8 at 3rd day; 48.2 ± 1.5 vs. 42.6 ± 1 at 5th day and 53.2 ± 1.8 vs. 45.3 ± 2.3 at 7th day). In addition, within the first 5 days of ventilation, PaO/FiO ratio significantly increased in both groups (p < 0.05) but a faster rate was recorded in the study group (176.2 ± 11.9 vs. 152.1 ± 7.5 at 1st day; 284.2 ± 16.7 vs. 210.8 ± 15.3 at 3rd day and 302.2 ± 21 vs. 233.7 ± 22.4 at 5th day, p < 0.05). Number of ventilator-free days during the first 28-days after burn injury was significantly higher in the study group (12.9 ± 5.7 vs. 9.5 ± 5.9 days; p < 0.05). Ventilation time, lengths of stay in the ICU and hospital length of stay were not significantly different across both groups (p > 0.05). In addition, duration time from ADRS onset to death and from admission to death were also remarkably longer in the study group (p < 0.05). Mortality rate was significant lower in the study group (24.2% vs. 63.6%; p < 0.01) within 7 days since onset of ARDS, but not significantly different after two weeks as well as at the 28th day after burns injury. Overall mortality rate was also not significant difference between two groups.
CONCLUSION
It is necessary to conduct further trials to find out the effectiveness of this ventilation strategy on burns injury induced ARDS.
目的
本研究旨在探讨肺开放策略通气对合并急性呼吸窘迫综合征（ARDS）的烧伤患者的可行性和影响。
方法
采用前瞻性研究，将 66 例中度至重度烧伤合并 ARDS 的患者随机分为对照组（按 ARDS 网络通气）和观察组（采用肺开放策略通气）。所有患者均采用容量控制模式通气直至撤机。
结果
所有患者的肺开放程序均安全，最佳呼气末正压（PEEP）为 14.8±1.8cmH2O。在 24 小时的肺复张和 PEEP 滴定后，氧合明显改善（PaO/FiO 比值从 119.8±7.4 增加到 263.4±11.6；p<0.01）。随着时间的推移，观察组的静态顺应性绝对值明显更高（第 1 天为 33.9±0.9，第 3 天为 48.4±1.5，第 5 天为 48.2±1.5，第 7 天为 53.2±1.8；第 1 天为 26.3±0.6，第 3 天为 35.7±0.8，第 5 天为 42.6±1，第 7 天为 45.3±2.3）。此外，在通气的前 5 天内，两组的 PaO/FiO 比值均显著增加（p<0.05），但观察组的增加速度更快（第 1 天为 176.2±11.9，第 3 天为 284.2±16.7，第 5 天为 302.2±21；第 1 天为 152.1±7.5，第 3 天为 210.8±15.3，第 5 天为 233.7±22.4，p<0.05）。观察组烧伤后 28 天内无呼吸机天数显著增加（12.9±5.7 天 vs. 9.5±5.9 天；p<0.05）。两组的通气时间、ICU 住院时间和住院时间均无显著差异（p>0.05）。此外，观察组从 ARDS 发病到死亡的时间以及从入院到死亡的时间也显著延长（p<0.05）。观察组在 ARDS 发病后 7 天内的死亡率明显较低（24.2% vs. 63.6%；p<0.01），但两周后以及烧伤后 28 天无显著差异。两组总体死亡率也无显著差异。
结论
有必要进行进一步的试验，以确定这种通气策略对烧伤引起的 ARDS 的有效性。
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