无创同步间歇指令通气在急性心源性肺水肿中的应用。

Utility of non-invasive synchronized intermittent mandatory ventilation in acute cardiogenic pulmonary edema.

机构信息

Department of Emergency Medicine, Faculty of Medicine Karabuk University, Karabuk, Turkey.

出版信息

Am J Emerg Med. 2022 Jun;56:71-76. doi: 10.1016/j.ajem.2022.03.044. Epub 2022 Mar 27.

DOI:10.1016/j.ajem.2022.03.044

PMID:35367682

Abstract

BACKGROUNDS

Acute cardiogenic pulmonary edema (ACPE), one of the outcomes of acute heart failure (AHF), is a common reason in a critical condition with respiratory distress. Non-invasive synchronized intermittent mandatory ventilation(nSIMV) mode, which includes inspiratory pressure in addition to positive end expiratory pressure with/without pressure support provided in the non-invasive continuous positive airway pressure plus/pressure support(nCPAP/PS) mode can be effective in hypercarbia and the associated changes in consciousness. This study aimed to demonstrate the efficacy of nSIMV in ACPE.

METHODS

Patients who presented with clinical acute respiratory failure and were admitted to the critical care unit of the emergency department with the diagnosis of ACPE were included. Patients were placed on non-invasive mechanical ventilators with an oronasal mask under the nCPAP/PS and nSIMV modes. Pulse and respiratory rate, systolic and diastolic blood pressure and Glasgow Coma Scores(GCS), HACOR(heart rate, acidosis, consciousness, oxygenation and respiratory rate) scores, pH, PaCO2, PaO2/FiO2 and lactate at the time of admission and at 30 and 60 min were evaluated.

RESULTS

Twenty-two patients were recruited, nCPAP/PS mode was 10 and nSIMV mode was 12. Although there was no statistically significant difference between the two groups in terms of the change in the relevant parameters from admission to 60 min, the decreases in PaCO2 and lactate levels (31.4% vs. 21.2%, p = 0.383; 68.8% vs. 47.1%, p = 0.224; respectively) and the increase in PaO2 and PaO2/FiO2 values (34% vs. 14.2%, p = 0.710 and 132.1% vs. 52.7%, p = 0.073; respectively) were higher in the nSIMV group.

CONCLUSION

The nSIMV mode is as effective as the nCPAP/PS mode in the treatment of patients with ACPE. We believe that the nSIMV mode can be preferable, particularly in patients with hypercarbia who have relatively lower GCS and oxygenation.

摘要

背景

急性心源性肺水肿（ACPE）是急性心力衰竭（AHF）的结果之一，是伴有呼吸窘迫的危急情况下常见的原因。除了提供的呼气末正压（positive end expiratory pressure）之外，无创同步间歇强制通气（non-invasive synchronized intermittent mandatory ventilation，nSIMV）模式还包括吸气压力，在无创持续气道正压通气（continuous positive airway pressure，CPAP）加/压力支持（pressure support，PS）模式中可以有效治疗高碳酸血症和相关的意识改变。本研究旨在证明 nSIMV 在 ACPE 中的疗效。

方法

纳入因临床急性呼吸衰竭并被诊断为 ACPE 而入住急诊科重症监护病房的患者。患者使用口鼻面罩在 nCPAP/PS 和 nSIMV 模式下接受无创机械通气。在入院时和 30 分钟和 60 分钟时评估脉搏和呼吸频率、收缩压和舒张压以及格拉斯哥昏迷评分（GCS）、HACOR（心率、酸中毒、意识、氧合和呼吸频率）评分、pH 值、PaCO2、PaO2/FiO2 和乳酸水平。

结果

共纳入 22 例患者，nCPAP/PS 模式 10 例，nSIMV 模式 12 例。虽然两组从入院到 60 分钟时相关参数的变化无统计学差异，但 PaCO2 和乳酸水平的下降（31.4%比 21.2%，p = 0.383；68.8%比 47.1%，p = 0.224；分别）和 PaO2 和 PaO2/FiO2 值的增加（34%比 14.2%，p = 0.710 和 132.1%比 52.7%，p = 0.073；分别）在 nSIMV 组更高。