Dennis J W, Eigen H, Ballantine T V, Grosfeld J L
J Pediatr Surg. 1980 Dec;15(6):971-6. doi: 10.1016/s0022-3468(80)80312-5.
A bronchopleural fistula (BPF) may complicate the management of patients with major pulmonary disease or thoracic surgery. Neonates with idiopathic respiratory distress syndrome and requiring ventilation are especially susceptible to pulmonary barotrauma, which may result in a BPF. Morbidity and mortality are consistently high. In ventilating patients with BPF, the effects of peak inspiratory pressure (PIP) and positive and expiratory pressure (PEEP) on air leak have not been documented. These relationships were studied in rabbits prepared by thoracotomy and creation of a standardized BPF. Randomized trials of various levels of PIP and PEEP were applied, and the percent of inspired tidal volume lost through the BPF calculated. The percent of inspired volume lost does not increase significantly from 10 to 30 cm H2O PIP (p greater than 0.05). Percent leak does increase significantly when increasing PEEP frm 0 to 16 cm H2O (p less than 0.001). Any PEEP greater than 6 cm H2O results in more air loss through the BPF than any level of PIP (p less than 0.01). Linear regressions through a common origin were calculated to illustrate the relationship of PIP versus leak and PEEP versus leak. The slopes of these lines (0.572 and 3.97, respectively) are significantly different (p less than 0.001). When using equal increments of PIP and PEEP, PEEP will have over a sixfold greater effect on air leak than doses PIP. These data suggests that PIP should be increased preferentially when ventilating patients with BPF in order to minimize air leak. PEEP less than 6 cm H2O can be used without any significant increase in the volume of air lost.
支气管胸膜瘘（BPF）可能会使患有严重肺部疾病或接受胸外科手术的患者的治疗变得复杂。患有特发性呼吸窘迫综合征且需要通气的新生儿尤其容易发生肺气压伤，这可能导致BPF。发病率和死亡率一直很高。在为患有BPF的患者通气时，吸气峰压（PIP）以及呼气末正压（PEEP）对漏气的影响尚未有文献记载。在通过开胸手术并制造标准化BPF制备的兔子身上对这些关系进行了研究。应用了不同水平PIP和PEEP的随机试验，并计算了通过BPF损失的吸入潮气量百分比。从10 cm H₂O至30 cm H₂O的PIP，吸入量损失百分比没有显著增加（p大于0.05）。当PEEP从0增加到16 cm H₂O时，漏气百分比显著增加（p小于0.001）。任何大于6 cm H₂O的PEEP导致通过BPF的空气损失都比任何水平的PIP更多（p小于0.01）。计算通过共同原点的线性回归以说明PIP与漏气以及PEEP与漏气之间的关系。这些线的斜率（分别为0.572和3.97）有显著差异（p小于0.001）。当使用相等增量的PIP和PEEP时，PEEP对漏气的影响将比PIP剂量大六倍以上。这些数据表明，在为患有BPF的患者通气时，应优先增加PIP以尽量减少漏气。可以使用小于6 cm H₂O的PEEP，而不会显著增加空气损失量。
