Cruces Pablo, Moreno Diego, Reveco Sonia, Ramírez Yenny, Díaz Franco
Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago, Chile.
Centro de Investigación de Medicina Veterinaria, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile.
Turk J Emerg Med. 2024 Apr 4;24(2):117-121. doi: 10.4103/tjem.tjem_339_22. eCollection 2024 Apr-Jun.
We report the feasibility of a combined approach of very low low tidal volume (VT) and mild therapeutic hypothermia (MTH) to decrease the ventilatory load in a severe COVID-19-related acute respiratory distress syndrome (ARDS) cohort. Inclusion criteria was patients ≥18-years-old, severe COVID-19-related ARDS, driving pressure ∆P >15 cmHO despite low-VT strategy, and extracorporeal therapies not available. MTH was induced with a surface cooling device aiming at 34°C. MTH was maintained for 72 h, followed by rewarming of 1°C per day. Data were shown in median (interquartile range, 25%-75%). Mixed effects analysis and Dunnett's test were used for comparisons. Seven patients were reported. Ventilatory load decreased during the first 24 h, minute ventilation (VE) decreased from 173 (170-192) to 152 (137-170) mL/kg/min ( = 0.007), and mechanical power (MP) decreased from 37 (31-40) to 29 (26-34) J/min ( = 0.03). At the end of the MTH period, the VT, , and plateau pressure remained consistently close to 3.9 mL/kg predicted body weight, 12 and 26 cmHO, respectively. A combined strategy of MTH and ultraprotective mechanical ventilation (MV) decreased VE and MP in severe COVID-19-related ARDS. The decreasing of ventilatory load may allow maintaining MV within safety thresholds.
我们报告了采用极低潮气量（VT）和轻度治疗性低温（MTH）相结合的方法来降低重症新型冠状病毒肺炎相关急性呼吸窘迫综合征（ARDS）队列通气负荷的可行性。纳入标准为年龄≥18岁、重症新型冠状病毒肺炎相关ARDS、尽管采用低潮气量策略驱动压∆P仍>15 cmH₂O且无法进行体外治疗。使用表面冷却装置诱导MTH至目标温度34°C。MTH维持72小时，随后每天复温1°C。数据以中位数（四分位间距，25%-75%）表示。采用混合效应分析和邓尼特检验进行比较。共报告7例患者。通气负荷在前24小时内下降，分钟通气量（VE）从173（170-192）降至152（137-170）mL/kg/min（P = 0.007），机械功率（MP）从37（31-40）降至29（26-34）J/min（P = 0.03）。在MTH期结束时，VT、PEEP和平台压分别持续稳定在接近预测体重的3.9 mL/kg、12和26 cmH₂O。MTH与超保护性机械通气（MV）相结合的策略可降低重症新型冠状病毒肺炎相关ARDS患者的VE和MP。通气负荷的降低可能使MV维持在安全阈值内。
