Küçük Murat, Uğur Yasin Levent, Öztürk Mehmet Celal, Cömert Bilgin, Gökmen Ali Necati, Ergan Begüm
Division of Intensive Care, Department of Internal Medicine, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey.
Division of Intensive Care, Department of Anaesthesiology and Reanimation, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey.
Turk Thorac J. 2022 Mar;23(2):109-114. doi: 10.5152/TurkThoracJ.2022.21149.
The effects of fiberoptic bronchoscopy are not elucidated in different mechanical ventilation modes. The present study aimed to evaluate the effects of fiberoptic bronchoscopy on lung mechanics, ventilation parameters, and gas exchange in 2 often-used modes, volume control and pressure control, in invasively ventilated patients followed up in the intensive care unit.
Eligible patients were screened and included in the study after intensive care unit-fiberoptic bronchoscopy database search. Patients who underwent fiberoptic bronchoscopy under volume control and pressure control mechanical ventilation modes were compared. The primary outcome was the occurrence of any complication within the first 24 hours after the procedure, and secondary outcomes were changes in lung mechanics (dynamic lung compliance and airway resistance) and gas exchange (arterial partial pressures of oxygen and carbon dioxide).
A total of 61 patients (median age: 69 years, 60.7% male) were included. Twenty-nine (47.5%) patients were ventilated in volume control mode and 32 (52.5%) in pressure control mode during the fiberoptic bronchoscopy procedure, and the median (interquartile range) duration of the procedure was 9 [8-11] minutes. Baseline dynamic lung compliance, airway resistance, arterial partial pressures of oxygen and carbon dioxide, and the fraction of inspired O2 were similar in both groups. After fiberoptic bronchoscopy, dynamic lung compliance decreased in both groups, and airway resistance and peak airway pressures increased but reached pre-fiberoptic bronchoscopy values at the 1st hour after the procedure. No significant differences were detected in both groups in terms of blood gas values and lung mechanics in the 1st and 24th hours after the procedure. In both groups, the 24th hour fraction of inspired O2 was the same as the pre-fiberoptic bronchoscopy values, but the ratio of arterial partial pressure of oxygen and the fraction of inspired O2 improved. No complications developed in patients within 24 hours after the procedure.
No differences were detected in terms of gas exchange and pulmonary mechanics, and complications in volume control and pressure control modes in critically ill intubated patients.
不同机械通气模式下纤维支气管镜检查的效果尚不明确。本研究旨在评估纤维支气管镜检查对重症监护病房中接受有创通气患者在两种常用模式（容量控制和压力控制）下的肺力学、通气参数及气体交换的影响。
通过重症监护病房 - 纤维支气管镜检查数据库搜索筛选出符合条件的患者并纳入研究。比较在容量控制和压力控制机械通气模式下接受纤维支气管镜检查的患者。主要结局是检查后24小时内任何并发症的发生情况，次要结局是肺力学（动态肺顺应性和气道阻力）及气体交换（动脉血氧分压和二氧化碳分压）的变化。
共纳入61例患者（中位年龄：69岁，男性占60.7%）。在纤维支气管镜检查过程中，29例（47.5%）患者采用容量控制模式通气，32例（52.5%）采用压力控制模式通气，检查的中位（四分位间距）持续时间为9[8 - 11]分钟。两组患者的基线动态肺顺应性、气道阻力、动脉血氧分压和二氧化碳分压以及吸入氧分数相似。纤维支气管镜检查后，两组患者的动态肺顺应性均下降，气道阻力和气道峰压升高，但在检查后第1小时达到纤维支气管镜检查前的值。检查后第1小时和第24小时，两组患者的血气值和肺力学方面均未检测到显著差异。两组患者在第24小时的吸入氧分数与纤维支气管镜检查前的值相同，但动脉血氧分压与吸入氧分数的比值有所改善。检查后24小时内患者未发生并发症。
在重症插管患者中，容量控制和压力控制模式在气体交换、肺力学及并发症方面未检测到差异。
