Davis K, Johnson D J, Branson R D, Campbell R S, Johannigman J A, Porembka D
Department of Surgery, University of Cincinnati, Medical Center, Ohio.
Arch Surg. 1993 Dec;128(12):1348-52. doi: 10.1001/archsurg.1993.01420240056010.
Elevated airway pressures during mechanical ventilation are associated with hemodynamic compromise and pulmonary barotrauma. We studied the cardiopulmonary effects of a pressure-limited mode of ventilation (airway pressure release ventilation) in patients with the adult respiratory distress syndrome.
Fifteen patients requiring intermittent mandatory ventilation (IMV) and positive end-expiratory pressure (PEEP) were studied. Following measurement of hemodynamic and ventilatory data, all patients were placed on airway pressure release ventilation (APRV). Cardiorespiratory measurements were repeated after a 2-hour stabilization period.
During ventilatory support with APRV, peak inspiratory pressure (62 +/- 10 vs 30 +/- 4 cm H2O) and PEEP (11 +/- 4 vs 7 +/- 2 cm H2O) were reduced compared with IMV. Mean airway pressure was higher with APRV (18 +/- 5 vs 24 +/- 4 cm H2O). There were no statistically significant differences in gas exchange or hemodynamic variables. Both cardiac output (8.7 +/- 1.8 vs 8.4 +/- 2.0 L/min) and partial pressure of oxygen in arterial blood (79 +/- 9 vs 86 +/- 11 mm Hg) were essentially unchanged.
Our results suggest that while airway pressure release ventilation can provide similar oxygenation and ventilation at lower peak and end-expiratory pressures, this offers no hemodynamic advantages.
机械通气期间气道压力升高与血流动力学损害及肺气压伤相关。我们研究了压力限制通气模式（气道压力释放通气）对成人呼吸窘迫综合征患者心肺功能的影响。
对15例需要间歇强制通气（IMV）和呼气末正压（PEEP）的患者进行研究。在测量血流动力学和通气数据后，所有患者均采用气道压力释放通气（APRV）。在2小时稳定期后重复进行心肺测量。
在采用APRV进行通气支持期间，与IMV相比，吸气峰压（62±10 vs 30±4 cm H₂O）和PEEP（11±4 vs 7±2 cm H₂O）降低。APRV时平均气道压力较高（18±5 vs 24±4 cm H₂O）。气体交换或血流动力学变量无统计学显著差异。心输出量（8.7±1.8 vs 8.4±2.0 L/min）和动脉血氧分压（79±9 vs 86±11 mmHg）基本未变。
我们的结果表明，虽然气道压力释放通气可在较低的吸气峰压和呼气末压力下提供相似的氧合和通气，但这并无血流动力学优势。
