Villar J, Slutsky A S
Intensive Care Unit, Hospital del Pino, Las Palmas, Canary Islands, Spain.
Resuscitation. 1993 Oct;26(2):183-92. doi: 10.1016/0300-9572(93)90178-s.
To test the hypothesis that treatment with hypothermia affects the course of overwhelming acute respiratory failure associated with sepsis.
Concurrent-controlled, prospective study.
Adult multidisciplinary ICU in a teaching hospital.
Nineteen consecutive patients with septic ARDS mechanically ventilated and a P(A-a)O2 > 500 Torr during 36 h on > or = 10 cm H2O of PEEP.
Patients were assigned to receive conventional treatment (n = 10) or conventional treatment plus mild hypothermia (32-35 degrees C) instituted as a last resort (n = 9).
Hypothermia (33.7 +/- 0.6 degrees C) was associated with a reduction in mortality rate (67% vs. 100%, P < 0.05), P(A-a)O2 (P < 0.001), heart rate (P < 0.001), cardiac index (P < 0.01), and QS/QT (P < 0.01). There were no significant differences in oxygen consumption (VO2) before (243 +/- 74 ml/min) and during treatment with hypothermia (246 +/- 87 ml/min) although O2 extraction increased during hypothermia (26 +/- 6 vs. 30 +/- 6%, P < 0.05).
This study suggests that hypothermia was effective in improving oxygenation and survival in patients with severe ARDS associated with sepsis, even though VO2 was unchanged.
检验低温治疗会影响与脓毒症相关的严重急性呼吸衰竭病程这一假设。
同期对照前瞻性研究。
一家教学医院的成人多学科重症监护病房。
19例连续的脓毒症急性呼吸窘迫综合征患者，机械通气，在呼气末正压≥10 cm H₂O时36小时内动脉血氧分压差（P(A-a)O₂）> 500托。
患者被分配接受常规治疗（n = 10）或作为最后手段采用的常规治疗加轻度低温（32 - 35摄氏度）（n = 9）。
低温（33.7±0.6摄氏度）与死亡率降低（67%对100%，P < 0.05）、P(A-a)O₂降低（P < 0.001）、心率降低（P < 0.001）、心脏指数降低（P < 0.01）以及肺内分流率（QS/QT）降低（P < 0.01）相关。低温治疗前（243±74 ml/min）和治疗期间氧耗量（VO₂）无显著差异（246±87 ml/min），尽管低温治疗期间氧摄取增加（26±6对30±6%，P < 0.05）。
本研究表明，低温治疗对改善与脓毒症相关的严重急性呼吸窘迫综合征患者的氧合和生存率有效，即便VO₂未改变。
