Lee Yoonje, Lee Sang-Hyun, Choi Hyuk Joong, Park Jinkyu, Hwang Sejin, Lim Tae Ho, Kim Changsun
Department of Emergency Medicine, Gangnam Sacred Heart Hospital, Hallym University, Chuncheon-si, Republic of Korea.
Department of Emergency Medicine, Hangang Sacred Heart Hospital, Hallym University, Chuncheon-si, Republic of Korea.
Emerg Med Int. 2020 Mar 31;2020:8913571. doi: 10.1155/2020/8913571. eCollection 2020.
Intermittent positive pressure ventilation (IPPV) can adversely affect cardiopulmonary resuscitation outcomes by increasing the intrathoracic pressure. Continuous flow insufflation of oxygen (CFIO) has been investigated as a potential alternative, but evidence supporting its superiority over intermittent positive pressure ventilation in cases of cardiac arrest is scant. The aim of the current study was to compare the effects of continuous flow insufflation of oxygen using a one-way valve during cardiopulmonary-resuscitation with intermittent positive pressure ventilation in a rat model of respiratory arrest.
Male Sprague-Dawley rats weighing 400∼450 g (from minimum to maximum) were randomly assigned to either a sham, IPPV, or CFIO group ( = 10 per group). Respiratory arrest was induced by blocking the endotracheal tube. Arterial blood gas analysis was performed during cardiopulmonary resuscitation to compare the oxygenation levels. Tissues were then harvested to compare the degrees of pulmonary barotrauma and ischemic brain injury.
Return of spontaneous circulation was observed in 6/10 rats in the IPPV group and 5/10 in the CFIO group. During cardiopulmonary resuscitation, the mean PaO was significantly higher in the CFIO group (83.10 mmHg) than in the IPPV group (56.10 mmHg). Lung biopsy revealed more inflammatory cells and marked thickening of the alveolar wall in the IPPV group; the group also exhibited a higher frequency of neuroglial cells and apoptotic bodies of pyramidal cells, resulting from ischemic injury.
In a rat model of respiratory arrest, CFIO using a one-way valve resulted in a greater level of oxygenation and less lung and brain injuries than with IPPV.
间歇性正压通气（IPPV）可通过增加胸内压对心肺复苏结果产生不利影响。持续气流氧气吹入（CFIO）已作为一种潜在的替代方法进行了研究，但在心脏骤停病例中支持其优于间歇性正压通气的证据很少。本研究的目的是在呼吸骤停的大鼠模型中比较心肺复苏期间使用单向阀进行持续气流氧气吹入与间歇性正压通气的效果。
体重400∼450克（从最小到最大）的雄性Sprague-Dawley大鼠被随机分为假手术组、IPPV组或CFIO组（每组n = 10）。通过阻塞气管导管诱导呼吸骤停。在心肺复苏期间进行动脉血气分析以比较氧合水平。然后采集组织以比较肺气压伤和缺血性脑损伤的程度。
IPPV组10只大鼠中有6只观察到自主循环恢复，CFIO组10只中有5只。在心肺复苏期间，CFIO组的平均动脉血氧分压（PaO）（83.10 mmHg）显著高于IPPV组（56.10 mmHg）。肺活检显示IPPV组有更多炎症细胞和肺泡壁明显增厚；该组还表现出神经胶质细胞和锥体细胞凋亡小体的频率更高，这是由缺血性损伤导致的。
在呼吸骤停的大鼠模型中，使用单向阀的CFIO比IPPV导致更高的氧合水平，且肺和脑损伤更少。
