Brunet F, Mira J P, Belghith M, Monchi M, Renaud B, Fierobe L, Hamy I, Dhainaut J F, Dall'ava-Santucci J
Intensive Care Unit, Cochin-Port-Royal University Hospital, Paris, France.
Am J Respir Crit Care Med. 1994 Jun;149(6):1557-62. doi: 10.1164/ajrccm.149.6.8004313.
Extracorporeal CO2 removal combined with low frequency positive pressure ventilation (ECCO2R-LFPPV) improves gas exchange and decreases peak pressures, respiratory rates, and tidal volumes in animals and in humans. Recent evidence suggests that pulmonary barotrauma results from lung overinflation rather than from high pressures. This study was to test the hypothesis whether ECCO2R-LFPPV could improve gas exchange without causing lung overinflation, despite the use of higher levels of PEEP, when compared with conventional mechanical ventilation. Eleven patients with severe adult respiratory distress syndrome (ARDS) who failed to respond to different modes of mechanical ventilation were treated with ECCO2R-LFPPV. Risk of pulmonary barotrauma was evaluated by static pressure-volume (P-V) curves and dynamic changes in volumes monitored by respiratory inductive plethysmography (Respitrace). ECCO2R-LFPPV PaO2/FIO2 increased from 79 +/- 21 to 207 +/- 108 (p = 0.003). Risk of barotrauma, as shown by the shape of the P-V curve, was present in all patients receiving mechanical ventilation even though most of them were treated with permissive hypoventilation. By contrast, no evidence of persistent lung overinflation could be detected by either static P-V curves or dynamic measurements in nine of 11 patients who were treated by ECCO2R-LFPPV. The two remaining patients had severe airway obstruction because of bleeding, and they remained ventilated with persistent risk of barotrauma. We conclude that ECCO2R-LFPPV improves gas exchange without causing lung overinflation in a majority of patients with ARDS.
体外二氧化碳清除联合低频正压通气（ECCO2R-LFPPV）可改善气体交换，并降低动物和人类的峰值压力、呼吸频率和潮气量。最近的证据表明，肺气压伤是由肺过度充气而非高压引起的。本研究旨在验证以下假设：与传统机械通气相比，尽管使用了较高水平的呼气末正压（PEEP），ECCO2R-LFPPV是否能在不引起肺过度充气的情况下改善气体交换。11例对不同机械通气模式无反应的重症成人呼吸窘迫综合征（ARDS）患者接受了ECCO2R-LFPPV治疗。通过静态压力-容积（P-V）曲线和呼吸感应体积描记法（Respitrace）监测的容积动态变化来评估肺气压伤风险。ECCO2R-LFPPV治疗后动脉血氧分压/吸入氧分数值（PaO2/FIO2）从79±21升高至207±108（p = 0.003）。尽管大多数接受机械通气的患者采用了允许性低通气治疗，但所有接受机械通气的患者均存在P-V曲线形状所示的气压伤风险。相比之下，在接受ECCO2R-LFPPV治疗的11例患者中，有9例通过静态P-V曲线或动态测量均未发现持续肺过度充气的证据。其余2例患者因出血导致严重气道阻塞，持续存在气压伤风险并仍需通气。我们得出结论，对于大多数ARDS患者，ECCO2R-LFPPV可改善气体交换且不会引起肺过度充气。
