Okamoto K, Kishi H, Choi H, Sato T
Department of Anesthesiology, Kumamoto University School of Medicine, Japan.
Chest. 1997 May;111(5):1366-74. doi: 10.1378/chest.111.5.1366.
We hypothesized that the continuous gas flow administration delivered through an insufflation catheter positioned above the carina during airway pressure release ventilation (APRV) would facilitate carbon dioxide (CO2) elimination, resulting in normocarbia with a substantially reduced peak airway pressure (Paw). To test this hypothesis, we compared intermittent positive pressure ventilation (IPPV), tracheal gas insufflation (TGI), APRV, and combined TGI and APRV (TGI + APRV).
Animal study with random application of four ventilatory modes in a canine restrictive-thorax model with and without pulmonary edema.
Research laboratory at Kumamoto (Japan) University School of Medicine.
Six mongrel dogs.
Application of four ventilatory modes (IPPV, TGI, APRV, and TGI + APRV).
TGI + APRV facilitated CO2 elimination. The peak Paw was significantly lower during TGI + APRV than during IPPV (nonpulmonary edema model; 15 +/- 4 vs 28 +/- 9 cm H2O; p < 0.05; pulmonary edema model: 20 +/- 4 vs 34 +/- 10 cm H2O; p < 0.05). Normocarbia was observed in both models. Neither TGI nor APRV alone maintained normocarbia.
The combined use of TGI and APRV is a more effective method of maintaining normocarbia with reduced peak Paw than either IPPV or APRV alone.
我们假设在气道压力释放通气（APRV）期间，通过置于隆突上方的吹入导管进行持续气流给药，将有助于二氧化碳（CO₂）的清除，从而实现正常碳酸血症，并显著降低气道峰值压力（Paw）。为验证这一假设，我们比较了间歇正压通气（IPPV）、气管内气体吹入（TGI）、APRV以及联合应用TGI和APRV（TGI + APRV）。
在有或没有肺水肿的犬类限制性胸廓模型中随机应用四种通气模式的动物研究。
日本熊本大学医学院的研究实验室。
六只杂种犬。
应用四种通气模式（IPPV、TGI、APRV和TGI + APRV）。
TGI + APRV有助于CO₂清除。在TGI + APRV期间，Paw峰值显著低于IPPV期间（非肺水肿模型；15±4 vs 28±9 cm H₂O；p < 0.05；肺水肿模型：20±4 vs 34±10 cm H₂O；p < 0.05）。在两个模型中均观察到正常碳酸血症。单独使用TGI或APRV均不能维持正常碳酸血症。
与单独使用IPPV或APRV相比，联合使用TGI和APRV是维持正常碳酸血症并降低Paw峰值的更有效方法。
