与传统的肺部保护性通风相比,通过体外二氧化碳去除促进的下潮量通风对心脏功能的影响
Peter J McGuigan1,2, Emma M Bowcock3,4, Nicholas A Barrett5,6
1Royal Victoria Hospital, Belfast, United Kingdom.
Critical care explorations
|January 12, 2024
概括
使用体外二氧化碳去除 (ECCO2R) 的低潮量通风在急性低血压呼吸衰竭患者中没有影响心脏功能. 这一策略并没有显著改变右心室功能或张力标志物.
科学领域:
- 关键护理医学 关键护理医学
- 心肺生理学 心肺生理学
- 机械通风机械通风机械通风
背景情况:
- 低潮量通风是急性缺血性呼吸衰竭 (AHRF) 的保护策略.
- 身体外的二氧化碳去除 (ECCO2R) 可以促进极低的潮体积通风.
- 以ECCO2R为辅助的低潮量通风对心脏功能,特别是右心室的影响尚不清楚.
研究的目的:
- 为了研究ECCO2R促进的下潮气体通风对AHRF患者心脏功能的影响.
- 评估右心室缩功能的变化,通过三环状平面缩外流 (TAPSE) 测量.
- 为了评估N-终端亲B型尿素 (NT-proBNP) 作为心脏应变标记物的变化.
主要方法:
- 在呼吸衰竭 (REST) 试验中,对pRotective vEntilation与静脉肺部辅助的子研究.
- 患有AHRF的患者随机分配到ECCO2R或通常的护理.
- 在基线和随机化后测量了胸外心声和NT-proBNP水平.
主要成果:
- 在ECCO2R组中,与通常护理 (5.2mL/kgPBW) 相比,获得了较低的中位潮流体积 (3.6mL/kgPBW) (p=0.01).
- 在ECCO2R和常规护理组之间没有观察到TAPSE的显著差异 (21.3毫米对20.1毫米,p=0.60).
- 两组之间NT-proBNP水平没有发现显著差异 (1121 pg/mL与1393 pg/mL,p=0.30).
结论:
- 在患有AHRF的患者中,使用ECCO2R降低潮体积并没有对心脏功能产生不利影响.
- 该策略并没有导致右心室缩外流或心脏应变标志物的显著变化.
- 在AHRF中,ECCO2R辅助的超低潮量通风似乎对心脏功能是安全的.
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