Moriña P, Herrera M, Venegas J, Mora D, Rodríguez M, Pino E
Intensive Care Unit, Hospital Juan Ramón Jiménez, Huelva, Spain.
Intensive Care Med. 1997 Jan;23(1):58-64. doi: 10.1007/s001340050291.
To determine whether nebulized salbutamol improves the respiratory mechanics of patients with adult respiratory distress syndrome (ARDS). We also assessed the mechanisms that contribute to high respiratory system resistances during this disease.
Eleven consecutive patients with ARDS without clinical evidence of chronic obstructive pulmonary disease, admitted to a polivalent intensive care unit, and mechanically ventilated with Siemens Elema Servo C ventilator at constant inspiratory flow.
Peak airway pressure (Ppeak), airway pressure immediately after end inspiratory occlusion (P1), plateau pressure (P2) and intrinsic positive end-expiratory pressure (PEEPi) were measured at baseline condition and then 5, 15, and 30 min after 1 mg of salbutamol had been administered via a nebulizer through the endotracheal tube. Partial pressure of arterial oxygen (PaO2), heart rate (HR) and mean blood pressure (BP) were monitored and minimal respiratory system resistances (Rrs, m), additional resistances (DRrs) and static compliance (Cst) were computed.
Between baseline and post-salbutamol, we observed changes in Ppeak, P1, P2, PEEPi and Rrs, m. As there were no significant differences between values at the different intervals during post administration, the results are described comparing baseline and 15 min post-salbutamol administration values. We found a significant decrease in Ppeak (4.9 +/- 0.8 cmH2O). P1 (3 +/- 0.6 cmH2O). P2 (2.1 +/- 0.6 cmH2O), PEEPi (1.9 +/- 0.5 cmH2O) and Rrs, m (1.9 +/- 0.3 cmH2O/1 s-1); DR, rs decreased in five patients, did not change in four and increased in two. HR, PaO2 and BP did not change.
a) Salbutamol administered through the endotracheal tube by a nebulizer device lessens respiratory system resistances and airway and alveolar pressures, and therefore could decrease the risk of barotrauma and alveolar damage; b) high respiratory system resistances in ARDS have an increased smooth muscle tone component that can be reversible with salbutamol.
确定雾化吸入沙丁胺醇是否能改善成人呼吸窘迫综合征（ARDS）患者的呼吸力学。我们还评估了该疾病期间导致呼吸系统高阻力的机制。
11例连续的ARDS患者，无慢性阻塞性肺疾病的临床证据，入住多价重症监护病房，使用西门子Elema Servo C呼吸机以恒定吸气流量进行机械通气。
在基线状态下，然后在通过气管内导管经雾化器给予1mg沙丁胺醇后5、15和30分钟，测量气道峰压（Ppeak）、吸气末屏气后立即测得的气道压力（P1）、平台压（P2）和内源性呼气末正压（PEEPi）。监测动脉血氧分压（PaO2）、心率（HR）和平均血压（BP），并计算最小呼吸系统阻力（Rrs，m）、附加阻力（DRrs）和静态顺应性（Cst）。
在基线和使用沙丁胺醇后，我们观察到Ppeak、P1、P2、PEEPi和Rrs，m的变化。由于给药后不同时间点的值之间无显著差异，因此结果描述为比较基线和使用沙丁胺醇后15分钟的值。我们发现Ppeak（4.9±0.8cmH2O）、P1（3±0.6cmH2O）、P2（2.1±0.6cmH2O）、PEEPi（1.9±0.5cmH2O）和Rrs，m（1.9±0.3cmH2O/1 s-1）显著降低；5例患者的DR，rs降低，4例不变，2例升高。HR、PaO2和BP无变化。
a）通过雾化器装置经气管内导管给予沙丁胺醇可降低呼吸系统阻力以及气道和肺泡压力，因此可降低气压伤和肺泡损伤的风险；b）ARDS中高呼吸系统阻力具有增加的平滑肌张力成分，可被沙丁胺醇逆转。
