Renz Miriam, Müllejans Leah, Riedel Julian, Mohnke Katja, Rissel René, Ziebart Alexander, Duenges Bastian, Hartmann Erik Kristoffer, Ruemmler Robert
Department of Anaesthesiology, University Medical Center, Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, Germany.
J Clin Med. 2022 Aug 22;11(16):4921. doi: 10.3390/jcm11164921.
Background: Invasive ventilation during cardiopulmonary resuscitation (CPR) is very complex due to unique thoracic pressure conditions. Current guidelines do not provide specific recommendations for ventilation during ongoing chest compressions regarding positive end-expiratory pressure (PEEP). This trial examines the cardiopulmonary effects of PEEP application during CPR. Methods: Forty-two German landrace pigs were anaesthetised, instrumented, and randomised into six intervention groups. Three PEEP levels (0, 8, and 16 mbar) were compared in high standard and ultralow tidal volume ventilation. After the induction of ventricular fibrillation, mechanical chest compressions and ventilation were initiated and maintained for thirty minutes. Blood gases, ventilation/perfusion ratio, and electrical impedance tomography loops were taken repeatedly. Ventilation pressures and haemodynamic parameters were measured continuously. Postmortem lung tissue damage was assessed using the diffuse alveolar damage (DAD) score. Statistical analyses were performed using SPSS, and p values <0.05 were considered significant. Results: The driving pressure (Pdrive) showed significantly lower values when using PEEP 16 mbar than when using PEEP 8 mbar (p = 0.045) or PEEP 0 mbar (p < 0.001) when adjusted for the ventilation mode. Substantially increased overall lung damage was detected in the PEEP 0 mbar group (vs. PEEP 8 mbar, p = 0.038; vs. PEEP 16 mbar, p = 0.009). No significant differences in mean arterial pressure could be detected. Conclusion: The use of PEEP during CPR seems beneficial because it optimises ventilation pressures and reduces lung damage without significantly compromising blood pressure. Further studies are needed to examine long-term effects in resuscitated animals.
由于独特的胸内压条件，心肺复苏（CPR）期间的有创通气非常复杂。当前指南未就持续胸外按压期间的呼气末正压（PEEP）通气提供具体建议。本试验研究了CPR期间应用PEEP的心肺效应。方法：42只德国长白猪麻醉后进行仪器植入，并随机分为6个干预组。在高标准和超低潮气量通气中比较了3个PEEP水平（0、8和16毫巴）。诱发心室颤动后，开始并维持机械胸外按压和通气30分钟。反复采集血气、通气/灌注比和电阻抗断层扫描环。持续测量通气压力和血流动力学参数。使用弥漫性肺泡损伤（DAD）评分评估死后肺组织损伤。使用SPSS进行统计分析，p值<0.05被认为具有统计学意义。结果：调整通气模式后，使用16毫巴PEEP时的驱动压力（Pdrive）显著低于使用8毫巴PEEP（p = 0.045）或0毫巴PEEP（p < 0.001）时的值。在0毫巴PEEP组中检测到总体肺损伤显著增加（与8毫巴PEEP组相比，p = 0.038；与16毫巴PEEP组相比，p = 0.009）。未检测到平均动脉压有显著差异。结论：CPR期间使用PEEP似乎有益，因为它优化了通气压力并减少了肺损伤，而不会显著影响血压。需要进一步研究以检查复苏动物的长期影响。
