推荐的减少 SARS-CoV-2 在无创通气支持期间气溶胶扩散的方法可能导致呼吸机性能恶化：一项基准比较研究。
Recommended Approaches to Minimize Aerosol Dispersion of SARS-CoV-2 During Noninvasive Ventilatory Support Can Cause Ventilator Performance Deterioration: A Benchmark Comparative Study.
机构信息
AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; Respiratory Department, Avicenne Hospital, AP-HP, Bobigny, France; Normandie University, UNIRouen, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France.
Normandie University, UNIRouen, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France; Kernel Biomedical, Bois-Guillaume, France.
出版信息
Chest. 2021 Jul;160(1):175-186. doi: 10.1016/j.chest.2021.02.047. Epub 2021 Mar 2.
BACKGROUND
SARS-CoV-2 aerosolization during noninvasive positive-pressure ventilation may endanger health care professionals. Various circuit setups have been described to reduce virus aerosolization. However, these setups may alter ventilator performance.
RESEARCH QUESTION
What are the consequences of the various suggested circuit setups on ventilator efficacy during CPAP and noninvasive ventilation (NIV)?
STUDY DESIGN AND METHODS
Eight circuit setups were evaluated on a bench test model that consisted of a three-dimensional printed head and an artificial lung. Setups included a dual-limb circuit with an oronasal mask, a dual-limb circuit with a helmet interface, a single-limb circuit with a passive exhalation valve, three single-limb circuits with custom-made additional leaks, and two single-limb circuits with active exhalation valves. All setups were evaluated during NIV and CPAP. The following variables were recorded: the inspiratory flow preceding triggering of the ventilator, the inspiratory effort required to trigger the ventilator, the triggering delay, the maximal inspiratory pressure delivered by the ventilator, the tidal volume generated to the artificial lung, the total work of breathing, and the pressure-time product needed to trigger the ventilator.
RESULTS
With NIV, the type of circuit setup had a significant impact on inspiratory flow preceding triggering of the ventilator (P < .0001), the inspiratory effort required to trigger the ventilator (P < .0001), the triggering delay (P < .0001), the maximal inspiratory pressure (P < .0001), the tidal volume (P = .0008), the work of breathing (P < .0001), and the pressure-time product needed to trigger the ventilator (P < .0001). Similar differences and consequences were seen with CPAP as well as with the addition of bacterial filters. Best performance was achieved with a dual-limb circuit with an oronasal mask. Worst performance was achieved with a dual-limb circuit with a helmet interface.
INTERPRETATION
Ventilator performance is significantly impacted by the circuit setup. A dual-limb circuit with oronasal mask should be used preferentially.
背景
SARS-CoV-2 在无创正压通气过程中的气溶胶化可能会危及医护人员的健康。已经描述了各种回路设置来减少病毒气溶胶化。然而，这些设置可能会改变呼吸机的性能。
研究问题
各种建议的回路设置对 CPAP 和无创通气 (NIV) 期间呼吸机效能有何影响？
研究设计和方法
在一个由三维打印头和人工肺组成的台架测试模型上评估了 8 种回路设置。设置包括带有口鼻面罩的双肢回路、带有头盔接口的双肢回路、带有被动呼气阀的单肢回路、带有三个定制附加泄漏的单肢回路和带有主动呼气阀的两个单肢回路。在 NIV 和 CPAP 期间评估了所有设置。记录了以下变量：触发呼吸机前的吸气流量、触发呼吸机所需的吸气努力、触发延迟、呼吸机提供的最大吸气压力、输送到人工肺的潮气量、呼吸总功和触发呼吸机所需的压力-时间乘积。
结果
在 NIV 期间，回路设置的类型对触发呼吸机前的吸气流量（P<0.0001）、触发呼吸机所需的吸气努力（P<0.0001）、触发延迟（P<0.0001）、最大吸气压力（P<0.0001）、潮气量（P=0.0008）、呼吸功（P<0.0001）和触发呼吸机所需的压力-时间乘积（P<0.0001）有显著影响。CPAP 以及添加细菌过滤器时也观察到类似的差异和后果。带有口鼻面罩的双肢回路表现最佳。带有头盔接口的双肢回路表现最差。
解释
呼吸机性能受到回路设置的显著影响。应优先使用带有口鼻面罩的双肢回路。
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