Vanwulpen Maxim, Bouillon Arthur, Cornelis Ruben, Dessers Bert, Hachimi-Idrissi Saïd
Emergency Department, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
Faculty of Medicine and Health Sciences, Ghent University, Sint-Pietersnieuwstraat 25, 9000 Ghent, Belgium.
J Clin Med. 2024 Jul 22;13(14):4274. doi: 10.3390/jcm13144274.
Intrathoracic airway closure frequently occurs during cardiac arrest, possibly impairing ventilation. Previously, capnogram analysis was used to detect this pathophysiological process. In other populations, quasi-static pressure-volume curves obtained during constant low-flow inflations are routinely used to detect intrathoracic airway closure. This study reports the first use of quasi-static pressure-volume curves to detect intrathoracic airway closure during prehospital cardiopulmonary resuscitation. Connecting a pressure and flow sensor to the endotracheal tube enabled the performance of low-flow inflations during cardiopulmonary resuscitation using a manual resuscitator. Users connected the device following intubation and performed a low-flow inflation during the next rhythm analysis when chest compressions were interrupted. Determining the lower inflection point on the resulting pressure-volume curves allowed for the detection and quantification of intrathoracic airway closure. The research device was used during the prehospital treatment of ten cardiac arrest patients. A lower inflection point indicating intrathoracic airway closure was detected in all patients. During cardiac arrest, the median pressure at which the lower inflection point occurred was 5.56 cmH20 (IQR 4.80, 8.23 cmH20). This value varied considerably between cases and was lower in patients who achieved return of spontaneous circulation. In this pilot study, quasi-static pressure-volume curves were obtained during prehospital cardiopulmonary resuscitation. Intrathoracic airway closure was detected in all patients. Further research is needed to determine whether the use of ventilation strategies to counter intrathoracic airway closure could lead to improved outcomes and if the degree of airway closure could serve as a prognostic factor.
心脏骤停期间常发生胸内气道闭合，这可能会损害通气功能。此前，二氧化碳波形图分析被用于检测这一病理生理过程。在其他人群中，在持续低流量充气过程中获得的准静态压力-容积曲线常被用于检测胸内气道闭合。本研究报告了首次在院外心肺复苏期间使用准静态压力-容积曲线来检测胸内气道闭合。将压力和流量传感器连接到气管导管上，使得在使用手动复苏器进行心肺复苏期间能够进行低流量充气。使用者在插管后连接该设备，并在下次胸外按压中断进行节律分析时进行低流量充气。确定所得压力-容积曲线上的下拐点，可检测和量化胸内气道闭合情况。该研究设备在10名心脏骤停患者的院外治疗中使用。在所有患者中均检测到表明胸内气道闭合的下拐点。心脏骤停期间，下拐点出现时的中位压力为5.56 cmH2O（四分位间距4.80，8.23 cmH2O）。该值在不同病例间差异很大，在实现自主循环恢复的患者中较低。在这项初步研究中，在院外心肺复苏期间获得了准静态压力-容积曲线。在所有患者中均检测到胸内气道闭合。需要进一步研究以确定使用通气策略对抗胸内气道闭合是否能改善预后，以及气道闭合程度是否可作为一个预后因素。
