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在窒息性心跳骤停的小猪儿心肺复苏期间的气道管理和潮气量反馈通气的影响。

Effects of airway management and tidal volume feedback ventilation during pediatric resuscitation in piglets with asphyxial cardiac arrest.

机构信息

Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Dr Castelo 47, 28009, Madrid, Spain.

Health Research Institute of the Gregorio Marañón Hospital, Madrid, Spain.

出版信息

Sci Rep. 2021 Aug 9;11(1):16138. doi: 10.1038/s41598-021-95296-w.

Abstract

To compare the effect on the recovery of spontaneous circulation (ROSC) of early endotracheal intubation (ETI) versus bag-mask ventilation (BMV), and expiratory real-time tidal volume (VTe) feedback (TVF) ventilation versus without feedback or standard ventilation (SV) in a pediatric animal model of asphyxial cardiac arrest. Piglets were randomized into five groups: 1: ETI and TVF ventilation (10 ml/kg); 2: ETI and TVF (7 ml/kg); 3: ETI and SV; 4: BMV and TVF (10 ml/kg) and 5: BMV and SV. Thirty breaths-per-minute guided by metronome were given. ROSC, pCO2, pO2, EtCO2 and VTe were compared among groups. Seventy-nine piglets (11.3 ± 1.2 kg) were included. Twenty-six (32.9%) achieved ROSC. Survival was non-significantly higher in ETI (40.4%) than BMV groups (21.9%), p = 0.08. No differences in ROSC were found between TVF and SV groups (30.0% versus 34.7%, p = 0.67). ETI groups presented lower pCO2, and higher pO2, EtCO2 and VTe than BMV groups (p < 0.05). VTe was lower in TVF than in SV groups and in BMV than in ETI groups (p < 0.05). Groups 1 and 3 showed higher pO2 and lower pCO2 over time, although with hyperventilation values (pCO2 < 35 mmHg). ETI groups had non significantly higher survival rate than BMV groups. Compared to BMV groups, ETI groups achieved better oxygenation and ventilation parameters. VTe was lower in both TVF and BMV groups. Hyperventilation was observed in intubated animals with SV and with 10 ml/kg VTF.

摘要

比较在窒息性心脏骤停的儿科动物模型中,早期气管内插管(ETI)与球囊面罩通气(BMV)、呼气实时潮气量(VTe)反馈(TVF)通气与无反馈或标准通气(SV)对自主循环恢复(ROSC)的影响。将小猪随机分为五组:1:ETI 和 TVF 通气(10 ml/kg);2:ETI 和 TVF(7 ml/kg);3:ETI 和 SV;4:BMV 和 TVF(10 ml/kg)和 5:BMV 和 SV。由节拍器引导每分钟 30 次呼吸。比较各组间 ROSC、pCO2、pO2、EtCO2 和 VTe。纳入 79 头小猪(11.3±1.2 kg)。26 头(32.9%)实现了 ROSC。ETI 组的存活率(40.4%)显著高于 BMV 组(21.9%),p=0.08。TVF 和 SV 组间 ROSC 无差异(30.0%与 34.7%,p=0.67)。ETI 组的 pCO2 较低,pO2、EtCO2 和 VTe 较高,与 BMV 组相比(p<0.05)。与 SV 组和 BMV 组相比,TVF 组的 VTe 较低(p<0.05)。尽管通气过度(pCO2<35 mmHg),但组 1 和 3 的 pO2 随时间升高,pCO2 降低。ETI 组的存活率显著高于 BMV 组。与 BMV 组相比,ETI 组的氧合和通气参数更好。与 BMV 组相比,两组的 VTe 均较低。SV 通气和 10 ml/kg VTF 通气的插管动物出现过度通气。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca43/8352976/d02226e92c2c/41598_2021_95296_Fig1_HTML.jpg

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