在脑死亡诊断中呼吸暂停期间持续供氧及使用呼气末正压通气。

The use of continuous flow of oxygen and PEEP during apnea in the diagnosis of brain death.

作者信息

Perel A, Berger M, Cotev S

出版信息

Intensive Care Med. 1983;9(1):25-7. doi: 10.1007/BF01693702.

Abstract

The establishment of apnea for the diagnosis of brain death by disconnecting the patient from the ventilator may lead to dangerous hypoxemia at the end of the test period. We established apnea for 4 min in 8 patients with suspected brain death, both by disconnecting them from the ventilator after 10 min ventilation with FIO2 = 1.0 (method "A"), and by leaving them attached to an IMV ventilator circuit with a continuous flow of 100% O2 and PEEP of 4-8 cm H2O without mechanical ventilation (method "B"). PaO2 decreased during the apneic period by 143 +/- 65 (SD) mmHg using method "A", and by 48 +/- 28 mmHg using method "B" (p less than 0.002). The changes in PaCO2 and pH were similar following both apneic methods. We conclude that it is safer to test for apnea by leaving the patients on a continuous flow of 100% oxygen and low PEEP than to disconnect them from the ventilator.

摘要

通过将患者与呼吸机断开连接来建立呼吸暂停以诊断脑死亡，在测试期结束时可能会导致危险的低氧血症。我们对8例疑似脑死亡患者分别采用两种方法建立4分钟的呼吸暂停：方法“A”为在10分钟吸入氧浓度（FIO2）=1.0的通气后将患者与呼吸机断开；方法“B”为让患者连接在持续通入100%氧气且呼气末正压（PEEP）为4 - 8 cmH2O的间歇指令通气（IMV）呼吸机回路中，不进行机械通气。采用方法“A”时，呼吸暂停期间动脉血氧分压（PaO2）下降了143±65（标准差）mmHg，采用方法“B”时下降了48±28 mmHg（p<0.002）。两种呼吸暂停方法后动脉血二氧化碳分压（PaCO2）和pH值的变化相似。我们得出结论，让患者持续吸入100%氧气并给予低PEEP来测试呼吸暂停比将他们与呼吸机断开连接更安全。