气道压力释放通风 (APRV) 与压力支通风 (PSV) - 一项前性干预试验,比较重症监护患者的血液动力学参数
Alexandru Ille1, Carl Nilsson1, Carl Sjödin1
1Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
Acta anaesthesiologica Scandinavica
|May 19, 2024
概括
气道压力释放通风 (APRV) 与压力支通风 (PSV) 相比,在没有严重肺病的重症监护病房患者中没有改变心脏指数. 然而,APRV确实降低了最高气道压力,并增加了平均气道压力.
科学领域:
- 临界护理医学 临界护理医学
- 心血管生理学心血管生理学
- 呼吸系统疗法 呼吸系统疗法
背景情况:
- 机械通风可以改变胸内压力,影响心脏血液动力学.
- 建议空气道压力释放通风 (APRV) 在严重的肺部疾病中具有血液动力学益处.
- 在非严重的肺病患者中APRV的血液动力学效应需要研究.
研究的目的:
- 为了比较APRV与压力支通风 (PSV) 对心脏指数的影响,在没有严重肺病的直管ICU患者中.
- 评估其他血液动力学和呼吸系统参数的二次变化.
主要方法:
- 一项交叉研究设计,涉及20名直管ICU患者.
- 患者在30分钟的间隔内使用APRV和PSV模式进行呼吸.
- 血液动力学监测包括脉冲诱导的持续心脏输出 (PiCCO) 导管测量.
主要成果:
- 在APRV和PSV (3.42对3.39L/分钟/米2) 之间没有观察到心脏指数的显著差异.
- APRV显著增加了中央静脉压力 (+1.0 mmHg) 和平均气道压力 (+2.1 cmH2O).
- 在不影响氧化指数的情况下,APRV显著降低了气道峰值压力 (-3.16 cmH2O).
结论:
- 与PSV相比,APRV在没有严重肺病的ICU患者中不会改变心脏指数.
- APRV导致气道峰值压力降低,气道平均压力提高.
- 在这种患者群体中,APRV的血液动力学效应需要进一步研究.
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