高原性肺水肿的初始治疗：氧气与自动 PEEP 的比较。
Initial Treatment of High-Altitude Pulmonary Edema: Comparison of Oxygen and Auto-PEEP.
机构信息
Department of Sport and Rehabilitation Medicine, University of Ulm, Leimgrubenweg 14, 89075 Ulm, Germany.
Department of General and Visceral Surgery, Krankenhaus Blaubeuren, Ulmer Straße 26, 89143 Blaubeuren, Germany.
出版信息
Int J Environ Res Public Health. 2022 Dec 3;19(23):16185. doi: 10.3390/ijerph192316185.
BACKGROUND
Improvement of oxygenation is the aim in the therapy of high-altitude pulmonary edema (HAPE). However, descent is often difficult and hyperbaric chambers, as well as bottled oxygen, are often not available. We compare Auto-PEEP (AP-Pat), a special kind of pursed lips breathing, against the application of bottled oxygen (O-Pat) in two patients suffering from HAPE.
METHODS
We compare the effect of these two different therapies on oxygen saturation measured by pulse oximetry (SpO) over time.
RESULT
In both patients SpO increased significantly from 65-70% to 95%. Above 80% this increase was slower in AP-Pat compared with O-Pat. Therapy started immediately in AP-Pat but was delayed in O-Pat because of organizational and logistic reasons.
CONCLUSIONS
The well-established therapies of HAPE are always the option of choice, if available, and should be started as soon as possible. The advantage of Auto-PEEP is its all-time availability. It improves SpO nearly as well as 3 L/min oxygen and furthermore has a positive effect on oxygenation lasting for approximately 120 min after stopping. Auto-PEEP treatment does not appear inferior to oxygen treatment, at least in this cross-case comparison. Its immediate application after diagnosis probably plays an important role here.
背景
改善氧合是治疗高原肺水肿（HAPE）的目标。然而，下降往往很困难，高压舱以及瓶装氧气通常无法获得。我们比较了 Auto-PEEP（AP-Pat），一种特殊的撅嘴呼吸方式，与两名患有 HAPE 患者的瓶装氧气（O-Pat）应用的效果。
方法
我们比较了这两种不同治疗方法在通过脉搏血氧饱和度（SpO）测量的时间内对氧饱和度的影响。
结果
在两名患者中，SpO 从 65-70%显著增加到 95%。在 AP-Pat 中，SpO 的增加速度明显比 O-Pat 慢，高于 80%。AP-Pat 中的治疗立即开始，但由于组织和后勤原因，在 O-Pat 中延迟。
结论
如果有条件，始终应选择已确立的 HAPE 治疗方法，并尽快开始。Auto-PEEP 的优势在于它随时可用。它几乎可以像 3 L/min 氧气一样改善 SpO，并且在停止后约 120 分钟内对氧合有积极影响。Auto-PEEP 治疗与氧气治疗至少在这种交叉案例比较中似乎没有区别。在诊断后立即应用可能在这里起着重要作用。
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