Sorkine P, Szold O, Kluger Y, Halpern P, Weinbroum A A, Fleishon R, Silbiger A, Rudick V
Department of Intensive Care & Anesthesiology, Tel Aviv Sourasky Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, Israel.
J Trauma. 1998 Jul;45(1):35-8. doi: 10.1097/00005373-199807000-00006.
To describe our experience with the use of limited peak inspiratory pressure (PIP), volume-controlled ventilation, and permissive hypercapnia in patients with severe pulmonary blast injury.
Patients with pulmonary blast injury were ventilated using volume-controlled, synchronized intermittent mandatory ventilation. Whenever PIP exceeded 40 cm H2O, the tidal volume was decreased to maintain PIP at less than 40 cm H2O. Whenever the arterial pH fell below 7.2, the ventilator rate was increased in increments of 2 breaths per minute until the arterial pH rose to 7.25.
Between 1994 and 1996, 17 patients with severe pulmonary blast injury (10 from enclosed space explosions and seven from open space ones), requiring mechanical ventilatory support were admitted to our intensive care unit. Four patients developed increasing PaCO2 levels (to 93 +/- 12 mm Hg) associated with the reduction in arterial pH that was corrected by increasing the ventilator rate. There was evidence of ventilator-induced pulmonary barotrauma. Of the 17 patients, 15 patients (88%) survived.
Limited PIP in a volume-controlled ventilation is a useful and safe mode of mechanical ventilation in patients with pulmonary blast injury.
描述我们在重度肺爆震伤患者中使用有限吸气峰压（PIP）、容量控制通气和允许性高碳酸血症的经验。
肺爆震伤患者采用容量控制、同步间歇指令通气进行通气。每当PIP超过40 cm H2O时，潮气量就会减少以维持PIP低于40 cm H2O。每当动脉血pH值降至7.2以下时，呼吸机频率就以每分钟增加2次呼吸的幅度增加，直到动脉血pH值升至7.25。
1994年至1996年期间，17例需要机械通气支持的重度肺爆震伤患者（10例来自密闭空间爆炸，7例来自开放空间爆炸）被收入我们的重症监护病房。4例患者出现PaCO2水平升高（至93±12 mmHg），伴有动脉血pH值降低，通过增加呼吸机频率得以纠正。有呼吸机所致肺气压伤的证据。17例患者中，15例（88%）存活。
在容量控制通气中限制PIP对肺爆震伤患者是一种有用且安全的机械通气模式。
