右心室流出道梗阻型先天性心脏病矫正手术后患者使用自主通气模式的交叉研究
Utilizing Spontaneous Ventilation Modes in Patients Underwent Corrective Surgery for Right Ventricular Outflow Tract Obstructive Congenital Heart Disease: A Crossover Study.
作者信息
Gong Xiaolei, Zhu Limin, Zhang Mingjie, Liu Yujie, Li Chunxiang, Xu Zhuoming, Zheng Jinghao
机构信息
Cardiac Intensive Care Unit, Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 200127 Shanghai, China.
Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 200127 Shanghai, China.
出版信息
Rev Cardiovasc Med. 2023 May 11;24(5):143. doi: 10.31083/j.rcm2405143. eCollection 2023 May.
BACKGROUND
This study aimed to determine whether the hemodynamics of patients with right ventricle outflow tract obstructive congenital heart disease (RVOTO-CHD) improve after corrective surgery by changing the ventilation mode.
METHODS
Patients with RVOTO-CHD who underwent corrective surgery were enrolled in this study. Echocardiography and advanced hemodynamic monitoring were performed using the pulse indicator continuous cardiac output (PiCCO) technology in the pressure-regulated volume control (PRVC) mode, followed with switching to the pressure support ventilation (PSV) mode and neurally adjusted ventilatory assist (NAVA) mode in random order.
RESULTS
Overall, 31 patients were enrolled in this study from April 2021 to October 2021. Notably, changing the ventilation mode from PRVC to a spontaneous mode (PSV or NAVA) led to better cardiac function outcomes, including right ventricular cardiac index (PRVC: 3.19 1.07 L/min/ PSV: 3.45 1.32 L/min/ NAVA: 3.82 1.03 L/min/ , 0.05) and right ventricle contractility (tricuspid annular peak systolic velocity) (PRVC: 6.58 1.40 cm/s PSV: 7.03 1.33 cm/s NAVA: 7.94 1.50 cm/s, 0.05), as detected via echocardiography. Moreover, in the NAVA mode, PiCCO-derived cardiac index (PRVC: 2.92 0.54 L/min/ PSV: 3.04 0.56 L/min/ NAVA: 3.20 0.62 L/min/ , 0.05), stroke volume index (PRVC: 20.38 3.97 mL/ PSV: 21.23 4.33 mL/ NAVA: 22.00 4.33 mL/ , 0.05), and global end diastolic index (PRVC: 295.74 78.39 mL/ PSV: 307.26 91.18 mL/ NAVA: 323.74 102.87 mL/ , 0.05) improved, whereas extravascular lung water index significantly reduced (PRVC: 16.42 7.90 mL/kg PSV: 15.42 5.50 mL/kg NAVA: 14.4 4.19 mL/kg, 0.05). Furthermore, peak inspiratory pressure, mean airway pressure, driving pressure, and compliance of the respiratory system improved in the NAVA mode. No deaths were reported in this study.
CONCLUSIONS
We found that utilizing spontaneous ventilator modes, especially the NAVA mode, after corrective surgery in patients with RVOTO-CHD may improve their right heart hemodynamics and respiratory mechanics. However, further randomized controlled trials are required to verify the advantages of spontaneous ventilation modes in such patients.
CLINICAL TRIAL REGISTRATION
NCT04825054.
背景
本研究旨在确定右心室流出道梗阻性先天性心脏病（RVOTO-CHD）患者在矫正手术后通过改变通气模式其血流动力学是否会得到改善。
方法
纳入接受矫正手术的RVOTO-CHD患者。采用脉搏指示连续心输出量（PiCCO）技术在压力调节容量控制（PRVC）模式下进行超声心动图和高级血流动力学监测，随后以随机顺序切换至压力支持通气（PSV）模式和神经调节通气辅助（NAVA）模式。
结果
总体而言，2021年4月至2021年10月共有31例患者纳入本研究。值得注意的是，将通气模式从PRVC改为自主模式（PSV或NAVA）可带来更好的心脏功能结果，包括右心室心脏指数（PRVC：3.19±1.07L/min/㎡；PSV：3.45±1.32L/min/㎡；NAVA：3.82±1.03L/min/㎡，P<0.05）和右心室收缩力（三尖瓣环收缩期峰值速度）（PRVC：6.58±1.40cm/s；PSV：7.03±1.33cm/s；NAVA：7.94±1.50cm/s，P<0.05），这通过超声心动图检测得出。此外，在NAVA模式下，PiCCO得出的心脏指数（PRVC：2.92±0.54L/min/㎡；PSV：3.04±0.56L/min/㎡；NAVA：3.20±0.62L/min/㎡，P<0.05）、每搏量指数（PRVC：20.38±3.97mL/㎡；PSV：21.23±4.33mL/㎡；NAVA：22.00±4.33mL/㎡，P<0.05）和全心舒张末期指数（PRVC：295.74±78.39mL/㎡；PSV：307.26±91.18mL/㎡；NAVA：323.74±102.87mL/㎡，P<0.05）均有所改善，而血管外肺水指数显著降低（PRVC：16.42±7.90mL/kg；PSV：15.42±5.50mL/kg；NAVA：14.4±4.19mL/kg，P<0.05）。此外，NAVA模式下吸气峰压、平均气道压、驱动压和呼吸系统顺应性均有所改善。本研究中未报告死亡病例。
结论
我们发现，RVOTO-CHD患者矫正手术后采用自主通气模式，尤其是NAVA模式，可能会改善其右心血流动力学和呼吸力学。然而，需要进一步的随机对照试验来验证自主通气模式在此类患者中的优势。
临床试验注册
NCT04825054。
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