脉冲剂量供氧在无创通气中的可行性和疗效。
Feasibility and Efficacy of Pulsed-Dose Oxygen Delivery During Noninvasive Ventilation.
机构信息
Department of Respiratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
Department of Respiratory Medicine, Tacheng District Hospital of Xinjiang Uygur Autonomous Region, Tacheng, China.
出版信息
Respir Care. 2020 Sep;65(9):1323-1332. doi: 10.4187/respcare.06922. Epub 2020 Aug 4.
BACKGROUND
It is difficult to apply noninvasive ventilation (NIV) simultaneously with pulsed-dose oxygen delivery. We evaluated the feasibility and efficacy of pulsed-dose oxygen delivery during NIV.
METHODS
A bench study was conducted using a simulated lung during NIV, with a breathing frequency of 10 or 20 breaths/min and 3 oxygen injection sites (site A on face mask, site B proximal to face mask, and site C at the ventilator outlet) with continuous flow oxygen delivery of 1, 3, or 5 L/min) or pulsed-dose oxygen delivery (numerical settings of 1, 3, or 5 representing the oxygen pulse characteristics). [Formula: see text] under different experimental conditions and the influence of mode of oxygen delivery on NIV (compared to baseline and continuous flow oxygen delivery vs pulsed-dose oxygen delivery) were compared. In the clinical study, we enrolled 10 subjects with COPD exacerbation who received NIV with either continuous flow oxygen delivery or pulsed-dose oxygen delivery. Under the same targeted pulse oxygen saturation (88-92%), the numerical settings of different modes of oxygen delivery were titrated, and the clinical parameters during the different modes of oxygen delivery were compared.
RESULTS
In the bench study, the ratio of the [Formula: see text] with pulsed-dose oxygen delivery to the [Formula: see text] with continuous flow oxygen delivery at the same numerical setting was 0.94 ± 0.15. The oxygen injection site had a significant influence on [Formula: see text] in pulsed-dose oxygen delivery or continuous flow oxygen delivery mode < .05). Pulsed-dose oxygen delivery worked effectively with the ventilator, as demonstrated by the fine synchronization in the breathing cycle of the ventilator, the simulated lung, and the pulsed-dose oxygen delivery. When compared with each other or compared to the baseline individually, pulsed-dose oxygen delivery and continuous flow oxygen delivery showed no clinically important effects on NIV (all > .05 or changes < 10%). In the clinical study, the mean numerical settings for pulsed-dose oxygen delivery and continuous flow oxygen delivery modes after titration were 2.68 ± 0.32 and 2.31 ± 0.56 L/min, respectively. There was no significant difference between continuous flow oxygen delivery and pulsed-dose oxygen delivery ( > .05).
CONCLUSIONS
Integration of pulsed-dose oxygen delivery into NIV could achieve efficacy similar to that achieved with continuous flow oxygen delivery.
背景
同时应用无创通气（NIV）和脉冲剂量给氧比较困难。我们评估了在 NIV 中应用脉冲剂量给氧的可行性和疗效。
方法
在 NIV 中使用模拟肺进行了一项床旁研究，呼吸频率为 10 或 20 次/分，3 个给氧部位（面罩上的部位 A、面罩近端的部位 B 和呼吸机出口处的部位 C），连续流量给氧 1、3 或 5 L/min）或脉冲剂量给氧（数值设定为 1、3 或 5，代表氧脉冲特征）。比较了不同实验条件下和给氧方式对 NIV 的影响（与基础值、连续流量给氧比较，与脉冲剂量给氧比较）。在临床研究中，我们纳入了 10 例 COPD 加重患者，他们在接受 NIV 治疗时，分别给予连续流量给氧或脉冲剂量给氧。在相同的目标脉冲血氧饱和度（88-92%）下，对不同给氧方式的数值设定进行滴定，并比较了不同给氧方式下的临床参数。
结果
在床旁研究中，在相同的数值设定下，脉冲剂量给氧时的[Formula: see text]与连续流量给氧时的[Formula: see text]的比值为 0.94 ± 0.15。给氧部位对脉冲剂量给氧或连续流量给氧模式下的[Formula: see text]有显著影响（ <.05）。脉冲剂量给氧与呼吸机配合良好，呼吸机、模拟肺和脉冲剂量给氧的呼吸周期精细同步。与各自的基础值或个体的基础值相比，脉冲剂量给氧和连续流量给氧对 NIV 均无明显临床影响（均 >.05 或变化 < 10%）。在临床研究中，滴定后脉冲剂量给氧和连续流量给氧模式的平均数值设定分别为 2.68 ± 0.32 和 2.31 ± 0.56 L/min，两者之间无显著差异（ >.05）。
结论
将脉冲剂量给氧整合到 NIV 中可以达到与连续流量给氧相似的疗效。
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