院外通气：气囊面罩装置与转运呼吸机的比较

Out-of-hospital ventilation: bag--valve device vs transport ventilator.

作者信息

Johannigman J A, Branson R D, Johnson D J, Davis K, Hurst J M

机构信息

Department of Surgery, University of Cincinnati Medical Center, OH 45267-0558, USA.

出版信息

Acad Emerg Med. 1995 Aug;2(8):719-24. doi: 10.1111/j.1553-2712.1995.tb03624.x.

DOI:10.1111/j.1553-2712.1995.tb03624.x

PMID:7584751

Abstract

OBJECTIVE

To examine the patterns of out-of-hospital airway management and to compare the efficacy of bag-valve ventilation with that of the use of a transport ventilator for intubated patients.

METHODS

A prospective, nonrandomized, convenience sample of 160 patients requiring airway management in the out-of-hospital urban setting was analyzed. A survey inquiring about airway and ventilatory management was completed by emergency medical services (EMS) personnel, and arterial blood gas (ABG) samples were obtained within 5 minutes of patient arrival in the ED. The ABG parameters were compared for patients grouped by different airway techniques and presence or absence of cardiac arrest (systolic blood pressure < 50 mm Hg) upon ED presentation.

RESULTS

Over a one-year period, 160 surveys were returned. The majority (62%) of the patients were men; the population mean age was 61 +/- 19 years. Presenting ABGs were obtained for 76 patients; 17% (13/76) had systemic perfusion and 83% (63/76) were in cardiac arrest. There was no difference in ABG parameters between the intubated cardiac arrest patients ventilated with a transport ventilator (pH 7.17 +/- 0.17, PaCO2 37 +/- 20 torr, and PaO2 257 +/- 142 torr) and those ventilated with a bag-valve device (pH 7.20 +/- 0.16, PaCO2 42 +/- 21 torr, and PaO2 217 +/- 138 torr). The patients ventilated via an esophageal obturator airway (EOA) device had impaired gas exchange, compared with the groups who had endotracheal (ET) intubation (pH 7.09 +/- 0.13, PaCO2 76 +/- 30 torr, and PaO2 75 +/- 35 torr). The intubated patients not in cardiac arrest had similar ABG parameters whether ventilated manually with a bag-valve device or with a transport ventilator. Endotracheal intubation was successfully accomplished in 93% (123/132) of attempted cases.

CONCLUSIONS

In this sample, ET intubation was the most frequently used airway by EMS providers. When ET intubation was accomplished, adequate ventilation could be achieved using either bag-valve ventilation or a transport ventilator. Ventilation via the EOA proved inadequate.

摘要

目的

研究院外气道管理模式，并比较球囊面罩通气与使用转运呼吸机对已插管患者的通气效果。

方法

对160例在城市院外环境中需要气道管理的患者进行前瞻性、非随机、便利抽样分析。由紧急医疗服务（EMS）人员完成一项关于气道和通气管理的调查，并在患者到达急诊科后5分钟内采集动脉血气（ABG）样本。比较根据不同气道技术分组以及在急诊科就诊时是否存在心脏骤停（收缩压<50 mmHg）的患者的ABG参数。

结果

在一年的时间里，共收回160份调查问卷。大多数患者（62%）为男性；总体平均年龄为61±19岁。76例患者获得了就诊时的ABG样本；17%（13/76）有全身灌注，83%（63/76）处于心脏骤停状态。使用转运呼吸机通气的已插管心脏骤停患者（pH 7.17±0.17，PaCO2 37±20托，PaO2 257±142托）与使用球囊面罩装置通气的患者（pH 7.20±0.16，PaCO2 42±21托，PaO2 217±138托）的ABG参数无差异。与经气管插管（ET）的组相比，通过食管阻塞气道（EOA）装置通气的患者气体交换受损（pH 7.09±0.13，PaCO2 76±30托，PaO2 75±35托）。未发生心脏骤停的已插管患者，无论使用球囊面罩装置手动通气还是使用转运呼吸机通气，其ABG参数相似。93%（123/132）的尝试插管病例成功完成了气管插管。