静脉内氧合器（IVOX）对急性呼吸窘迫综合征（ARDS）患者呼吸机设置的降低作用。

Reduction of ventilator settings allowed by intravenous oxygenator (IVOX) in ARDS patients.

作者信息

Mira J P, Brunet F, Belghith M, Soubrane O, Termignon J L, Renaud B, Hamy I, Monchi M, Deslande E, Fierobe L

机构信息

Service de Réanimation Médicale, Hôpital Cochin, Paris, France.

出版信息

Intensive Care Med. 1995 Jan;21(1):11-7. doi: 10.1007/BF02425148.

DOI:10.1007/BF02425148

PMID:7560467

Abstract

OBJECTIVE

To evaluate the possibility of reducing ventilator settings to "safe" levels by extrapulmonary gas exchange with IVOX in ARDS patients.

DESIGN

Uncontrolled open clinical study.

SETTING

Medical Intensive Care Unit of a University Hospital.

PATIENTS

6 patients with ARDS who entered into IVOX phase II clinical trials.

INTERVENTIONS

The end-point of this study was to reduce ventilator settings from the initial values, recorded on the day of inclusion, to the following: peak inspiratory pressure < 40 cmH2O, mean airway pressure < 25 cmH2O and tidal volume < 10 ml/kg. Trials to achieve this goal were made on volume-controlled ventilation within the 24 h before and after IVOX insertion. Comparison of the results achieved during these trials used Wilcoxon test.

RESULTS

Before IVOX implantation reduction of ventilator settings was not possible in the 6 patients, despite a non-significant increase in PaO2/FIO2 was achieved. IVOX permitted significant decrease in PaCO2 (from 60.5 +/- 15 to 52 +/- 11 mmHg; p = 0.02) before any modification of the ventilatory mode. After IVOX insertion, a significant decrease of the ventilator settings was performed: peak and mean airway pressures dropped from 44 +/- 10 to 36.8 +/- 6.7; p = 0.02 and from 26.3 +/- 5.6 to 22.5 +/- 3.9 cmH2O; p = 0.02, respectively. Concommitantly, PaCO2 remained unchanged and PaO2/FIO2 increased significantly from 93 +/- 28 to 117 +/- 52; p = 0.04. The interruption of oxygen flow on IVOX was associated with a slight decrease of the oxygen variables. Tolerance of IVOX was satisfactory. However, a significant decrease both in cardiac index and in pulmonary wedge pressures (from 4.5 +/- 1.2 to 3.4 +/- 9; p = 0.03 and from 16 +/- 5 to 11 +/- 2; p = 0.04, respectively) was observed.

CONCLUSION

Gas exchange achieved by IVOX allowed reduction of ventilator settings in 6 ARDS patients in whom previous attempts have failed. CO2 removal by the device, may explain these results. Efficacy of IVOX on arterial oxygenation was uncertain.

摘要

目的

评估在急性呼吸窘迫综合征（ARDS）患者中通过IVOX进行肺外气体交换将呼吸机设置降低至“安全”水平的可能性。

设计

非对照开放性临床研究。

地点

一所大学医院的医学重症监护病房。

患者

6名进入IVOX II期临床试验的ARDS患者。

干预措施

本研究的终点是将呼吸机设置从纳入当天记录的初始值降低至以下水平：吸气峰压<40 cmH₂O、平均气道压<25 cmH₂O和潮气量<10 ml/kg。在插入IVOX前后24小时内，在容量控制通气模式下尝试实现这一目标。这些试验期间取得的结果采用Wilcoxon检验进行比较。

结果

在6名患者中，在植入IVOX之前，尽管PaO₂/FIO₂有不显著的升高，但仍无法降低呼吸机设置。在未改变通气模式的情况下，IVOX使PaCO₂显著降低（从60.5±15降至52±11 mmHg；p = 0.02）。插入IVOX后，呼吸机设置显著降低：吸气峰压和平均气道压分别从44±10降至36.8±6.7；p = 0.02，以及从26.3±5.6降至22.5±3.9 cmH₂O；p = 0.02。同时，PaCO₂保持不变，PaO₂/FIO₂从93±28显著升高至117±52；p = 0.04。IVOX上的氧流中断与氧变量的轻微下降有关。IVOX的耐受性良好。然而，观察到心脏指数和肺楔压均显著下降（分别从4.5±1.2降至3.4±0.9；p = 0.03，以及从16±5降至11±2；p = 0.04）。