个体化流量控制与压力控制通气在猪油酸诱导的急性呼吸窘迫综合征模型中的比较。

Individualised flow-controlled versus pressure-controlled ventilation in a porcine oleic acid-induced acute respiratory distress syndrome model.

机构信息

From the Department of Anaesthesia and Intensive Care Medicine (JA, JM, PS, GP, MR, JW), Department of Radiology, Medical University of Innsbruck (BG), Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck, Innsbruck, Austria (TH), University of Greenwich, London, UK (TB), Faculty of Medicine, University of Münster, Münster, Germany (DE).

出版信息

Eur J Anaesthesiol. 2023 Jul 1;40(7):511-520. doi: 10.1097/EJA.0000000000001807. Epub 2023 Feb 7.

DOI:10.1097/EJA.0000000000001807

PMID:36749046

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10256303/

Abstract

BACKGROUND

A continuous gas flow provided by flow-controlled ventilation (FCV) facilitates accurate dynamic compliance measurement and allows the clinician to individually optimise positive end-expiratory and peak pressure settings accordingly.

OBJECTIVE

The aim of this study was to compare the efficiency of gas exchange and impact on haemodynamics between individualised FCV and pressure-controlled ventilation (PCV) in a porcine model of oleic acid-induced acute respiratory distress syndrome (ARDS).

DESIGN

Randomised controlled interventional trial conducted on 16 pigs.

SETTING

Animal operating facility at the Medical University Innsbruck.

INTERVENTIONS

ARDS was induced in lung healthy pigs by intravenous infusion of oleic acid until moderate-to-severe ARDS at a stable Horowitz quotient (PaO 2 FiO 2-1 ) of 80 to 120 over a period of 30 min was obtained. Ventilation was then either performed with individualised FCV ( n = 8) established by compliance-guided pressure titration or PCV ( n = 8) with compliance-guided titration of the positive end-expiratory pressure and peak pressure set to achieve a tidal volume of 6 ml kg -1 over a period of 2 h.

MAIN OUTCOME MEASURES

Gas exchange parameters were assessed by the PaO 2 FiO 2-1 quotient and CO 2 removal by the PaCO 2 value in relation to required respiratory minute volume. Required catecholamine support for haemodynamic stabilisation was measured.

RESULTS

The FCV group showed significantly improved oxygenation [149.2 vs. 110.4, median difference (MD) 38.7 (8.0 to 69.5) PaO 2 FiO 2-1 ; P = 0.027] and CO 2 removal [PaCO 2 7.25 vs. 9.05, MD -1.8 (-2.87 to -0.72) kPa; P = 0.006] at a significantly lower respiratory minute volume [8.4 vs. 11.9, MD -3.6 (-5.6 to -1.5) l min -1 ; P = 0.005] compared with PCV. In addition, in FCV-pigs, haemodynamic stabilisation occurred with a significant reduction of required catecholamine support [norepinephrine 0.26 vs. 0.86, MD -0.61 (-1.12 to -0.09) μg kg -1 min -1 ; P = 0.037] during 2 ventilation hours.

CONCLUSION

In this oleic acid-induced porcine ARDS model, individualised FCV significantly improved gas exchange and haemodynamic stability compared with PCV.

TRIAL REGISTRATION

Protocol no.: BMBWF-66.011/0105-V/3b/2019).

摘要

背景

流量控制通气（FCV）提供的持续气流有助于准确测量动态顺应性，并使临床医生能够相应地单独优化呼气末正压和峰值压力设置。

目的

本研究旨在比较油酸诱导的急性呼吸窘迫综合征（ARDS）猪模型中个体化 FCV 和压力控制通气（PCV）在气体交换效率和对血液动力学的影响。

设计

在 16 头猪上进行的随机对照干预试验。

地点

因斯布鲁克医科大学动物操作设施。

干预措施

通过静脉内输注油酸诱导肺健康猪发生 ARDS，直到 Horowitz 商数（PaO 2 FiO 2-1 ）稳定在 80 至 120 之间，持续 30 分钟，以获得中度至重度 ARDS。然后，通过顺应性指导压力滴定建立个体化 FCV（n = 8）或通过顺应性指导滴定呼气末正压和峰值压力来进行 PCV（n = 8），以实现 6 分钟通气量 ml/kg -1 ，持续 2 小时。

主要观察结果

通过 PaO 2 FiO 2-1 商数评估气体交换参数，通过 PaCO 2 值评估 CO 2 清除与所需呼吸分钟量的关系。测量为血液动力学稳定所需的儿茶酚胺支持。

结果

FCV 组的氧合明显改善[149.2 与 110.4，中位数差异（MD）38.7（8.0 至 69.5）PaO 2 FiO 2-1 ；P = 0.027]和 CO 2 清除[PaCO 2 7.25 与 9.05，MD -1.8（-2.87 至 -0.72）kPa；P = 0.006]，同时呼吸分钟量显著降低[8.4 与 11.9，MD -3.6（-5.6 至 -1.5）l/min ；P = 0.005]与 PCV 相比。此外，在 FCV 猪中，通过显著减少所需儿茶酚胺支持[去甲肾上腺素 0.26 与 0.86，MD -0.61（-1.12 至 -0.09）μg/kg/min ；P = 0.037]，在 2 小时通气期间实现了血液动力学稳定。