使用神经调节通气辅助通气进行双侧肺移植后的肺容量反馈和通气模式。

Pulmonary volume-feedback and ventilatory pattern after bilateral lung transplantation using neurally adjusted ventilatory assist ventilation.

机构信息

Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy.

Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

出版信息

Br J Anaesth. 2021 Jul;127(1):143-152. doi: 10.1016/j.bja.2021.03.010. Epub 2021 Apr 21.

DOI:10.1016/j.bja.2021.03.010

PMID:33892948

Abstract

BACKGROUND

Bilateral lung transplantation results in pulmonary vagal denervation, which potentially alters respiratory drive, volume-feedback, and ventilatory pattern. We hypothesised that Neurally Adjusted Ventilatory Assist (NAVA) ventilation, which is driven by diaphragm electrical activity (EAdi), would reveal whether vagally mediated pulmonary-volume feedback is preserved in the early phases after bilateral lung transplantation.

METHODS

We prospectively studied bilateral lung transplant recipients within 48 h of surgery. Subjects were ventilated with NAVA and randomised to receive 3 ventilatory modes (baseline NAVA, 50%, and 150% of baseline NAVA values) and 2 PEEP levels (6 and 12 cm HO). We recorded airway pressure, flow, and EAdi.

RESULTS

We studied 30 subjects (37% female; age: 37 (27-56) yr), of whom 19 (63%) had stable EAdi. The baseline NAVA level was 0.6 (0.2-1.0) cm HO μV. Tripling NAVA level increased the ventilatory peak pressure over PEEP by 6.3 (1.8), 7.6 (2.4), and 8.7 (3.2) cm HO, at 50%, 100%, and 150% of baseline NAVA level, respectively (P<0.001). EAdi peak decreased by 10.1 (9.0), 9.5 (9.4) and 8.8 μV (8.7) (P<0.001), accompanied by small increases in tidal volume, 8.3 (3.0), 8.7 (3.6), and 8.9 (3.3) ml kg donor's predicted body weight at 50%, 100%, and 150% of baseline NAVA levels, respectively (P<0.001). Doubling PEEP did not affect tidal volume.

CONCLUSIONS

NAVA ventilation was feasible in the majority of patients during the early postoperative period after bilateral lung transplantation. Despite surgical vagotomy distal to the bronchial anastomoses, bilateral lung transplant recipients maintained an unmodified respiratory pattern in response to variations in ventilatory assistance and PEEP.

CLINICAL TRIAL REGISTRATION

NCT03367221.

摘要

背景

双侧肺移植会导致肺迷走神经去神经支配，这可能会改变呼吸驱动、容量反馈和通气模式。我们假设，由膈肌电活动（EAdi）驱动的神经调节辅助通气（NAVA）可以揭示在双侧肺移植后早期阶段，迷走神经介导的肺容量反馈是否得到保留。

方法

我们前瞻性地研究了手术后 48 小时内的双侧肺移植受者。受者接受 NAVA 通气，并随机接受 3 种通气模式（基础 NAVA、基础 NAVA 的 50%和 150%）和 2 种 PEEP 水平（6 和 12 cm H2O）。我们记录气道压力、流量和 EAdi。

结果

我们研究了 30 名受试者（37%为女性；年龄：37（27-56）岁），其中 19 名（63%）的 EAdi 稳定。基础 NAVA 水平为 0.6（0.2-1.0）cm H2O μV。NAVA 水平增加 3 倍，分别在 50%、100%和 150%基础 NAVA 水平时，通气峰压超过 PEEP 增加 6.3（1.8）、7.6（2.4）和 8.7（3.2）cm H2O（P<0.001）。EAdi 峰值下降 10.1（9.0）、9.5（9.4）和 8.8 μV（8.7）（P<0.001），潮气量分别增加 8.3（3.0）、8.7（3.6）和 8.9（3.3）ml kg 供体预测体重，在 50%、100%和 150%基础 NAVA 水平时，分别增加 8.3（3.0）、8.7（3.6）和 8.9（3.3）ml kg 供体预测体重（P<0.001）。增加 PEEP 一倍不会影响潮气量。