Colmenero-Ruiz M, Fernández-Mondéjar E, Fernández-Sacristán M A, Rivera-Fernández R, Vazquez-Mata G
Department of Intensive Medicine, Virgin de las Nieves Hospital, Granada, Spain.
Am J Respir Crit Care Med. 1997 Mar;155(3):964-70. doi: 10.1164/ajrccm.155.3.9117033.
This study analyzed the effect of both positive end-expiratory pressure (PEEP) and reduction in tidal volume (VT) on extravascular lung water (EVLW) in a permeability model of pulmonary edema. Immediately after producing a pulmonary edema with oleic acid, 21 pigs were randomized into three groups. Group I (n = 8): PEEP of 0 cm H2O (ZEEP), VT of 12 ml/kg; Group II (n = 6): PEEP of 10 cm H2O, VT of 12 ml/kg; Group III (n = 7): PEEP of 10 cm H2O, VT of 6 ml/kg. EVLW was measured by the double indicator method (DI) at baseline (time 0) and after 30, 60, 120, 180, and 240 min and by the gravimetric method (G) at 240 min. Both methods correlated excellently (r = 0.94, p < 0.0001). EVLW-DI was significantly less with PEEP application (Group II versus Group I) at 180 min and thereafter. Likewise, EVLW-DI was less throughout the experimental period with reduced VT once PEEP was applied (Group III versus Group II). EVLW-G was less in Group II than in Group I at 16.3 +/- 2.7 and 23.2 +/- 4.2 ml/kg, respectively (p < 0.0001), and less in Group III than in Group II at 10.7 +/- 0.9 and 16.3 +/- 2.7 ml/kg (p < 0.0001). We conclude that early application of 10 cm H2O of PEEP reduces EVLW in permeability pulmonary edema. The lowering of VT reduced EVLW even further.
本研究在肺水肿通透性模型中分析了呼气末正压（PEEP）和潮气量（VT）降低对血管外肺水（EVLW）的影响。在用油酸制造肺水肿后，立即将21头猪随机分为三组。第一组（n = 8）：呼气末正压为0 cmH₂O（零呼气末正压），潮气量为12 ml/kg；第二组（n = 6）：呼气末正压为10 cmH₂O，潮气量为12 ml/kg；第三组（n = 7）：呼气末正压为10 cmH₂O，潮气量为6 ml/kg。在基线（时间0）以及30、60、120、180和240分钟后，采用双指示剂法（DI）测量血管外肺水，并在240分钟时采用重量法（G）测量。两种方法相关性极佳（r = 0.94，p < 0.0001）。在180分钟及之后，应用呼气末正压时（第二组与第一组相比），血管外肺水 - 双指示剂法测量值显著降低。同样，一旦应用呼气末正压，在整个实验期间，降低潮气量时血管外肺水 - 双指示剂法测量值更低（第三组与第二组相比）。在16.3±2.7和23.2±4.2 ml/kg时，第二组的血管外肺水 - 重量法测量值分别低于第一组（p < 0.0001），在10.7±0.9和16.3±2.7 ml/kg时，第三组的血管外肺水 - 重量法测量值低于第二组（p < 0.0001）。我们得出结论，早期应用10 cmH₂O的呼气末正压可降低通透性肺水肿中的血管外肺水。潮气量的降低进一步降低了血管外肺水。
