Improved lung recruitment and oxygenation during mandatory ventilation with a new expiratory ventilation assistance device: A controlled interventional trial in healthy pigs.
Improved lung recruitment and oxygenation during mandatory ventilation with a new expiratory ventilation assistance device: A controlled interventional trial in healthy pigs.
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DOI：
10.1097/eja.0000000000000819
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发表时间：
2018-10
影响因子：
3.6
通讯作者：
Schumann S
中科院分区：
文献类型：
--
作者：
Schmidt J;Wenzel C;Mahn M;Spassov S;Cristina Schmitz H;Borgmann S;Lin Z;Haberstroh J;Meckel S;Eiden S;Wirth S;Buerkle H;Schumann S
与传统的强制通气相比，一种新的通气模式，呼气通气辅助（EVA），使呼气气管压力下降线性化。我们假设由于招募效应，线性呼气氧合比容积控制通气（VCV）更好。在健康猪围手术期强制通气模型中，我们比较了EVA与VCV模式在气体交换、通气量、通压和肺通气量方面的差异。对照介入试验。大学医疗中心的动物操作设施。德国长白杂交猪共16头。麻醉猪采用EVA模式（n=9）或VCV模式（对照组，n=7）通气5 h，呼气末正压5 cmH2O，潮气量8 ml kg−1。呼吸率调整为目标潮汐末二氧化碳4.7至6千帕。反复记录气管压、分气量、动脉血气。进行计算机胸部断层扫描以量化正常和不良通气肺组织的百分比。EVA组2只动物因通气不稳定（n=1）或FiO2输送不稳定（n=1）而被排除。EVA组平均气管压力和PaO2高于对照组（平均气管压力：11.6±0.4比9.0±0.3 cmH2O, P < 0.001, PaO2: 19.2±0.7比17.5±0.4 kPa, P = 0.002），吸入气管压力峰值相似（18.3±0.9比18.0±1.2 cmH2O, P > 0.99）。与对照组相比，EVA组的分钟体积较低（5.5±0.2 vs 7.0±1.0 l min - 1, P = 0.02），两组的PaCO2均为正常通气（PaCO2 5.4±0.3 vs 5.5±0.3 kPa, P = 0.99）。与对照组相比，EVA组正常通气肺组织比例（81.0±3.6比75.8±3.0%,P = 0.017）较高，通气不良肺组织比例（9.5±3.3比15.7±3.5%,P = 0.002）较低。EVA通气通过提高平均气管压改善肺通气，从而在未改变的呼气末正压（PEEP）和吸气峰压（PIP）下改善动脉氧合。提示EVA模式是保护性肺通气的新途径。
Supplemental Digital Content is available in the text In contrast to conventional mandatory ventilation, a new ventilation mode, expiratory ventilation assistance (EVA), linearises the expiratory tracheal pressure decline. We hypothesised that due to a recruiting effect, linearised expiration oxygenates better than volume controlled ventilation (VCV). We compared the EVA with VCV mode with regard to gas exchange, ventilation volumes and pressures and lung aeration in a model of peri-operative mandatory ventilation in healthy pigs. Controlled interventional trial. Animal operating facility at a university medical centre. A total of 16 German Landrace hybrid pigs. The lungs of anaesthetised pigs were ventilated with the EVA mode (n=9) or VCV (control, n=7) for 5 h with positive end-expiratory pressure of 5 cmH2O and tidal volume of 8 ml kg−1. The respiratory rate was adjusted for a target end-tidal CO2 of 4.7 to 6 kPa. Tracheal pressure, minute volume and arterial blood gases were recorded repeatedly. Computed thoracic tomography was performed to quantify the percentages of normally and poorly aerated lung tissue. Two animals in the EVA group were excluded due to unstable ventilation (n=1) or unstable FiO2 delivery (n=1). Mean tracheal pressure and PaO2 were higher in the EVA group compared with control (mean tracheal pressure: 11.6 ± 0.4 versus 9.0 ± 0.3 cmH2O, P < 0.001 and PaO2: 19.2 ± 0.7 versus 17.5 ± 0.4 kPa, P = 0.002) with comparable peak inspiratory tracheal pressure (18.3 ± 0.9 versus 18.0 ± 1.2 cmH2O, P > 0.99). Minute volume was lower in the EVA group compared with control (5.5 ± 0.2 versus 7.0 ± 1.0 l min−1, P = 0.02) with normoventilation in both groups (PaCO2 5.4 ± 0.3 versus 5.5 ± 0.3 kPa, P > 0.99). In the EVA group, the percentage of normally aerated lung tissue was higher (81.0 ± 3.6 versus 75.8 ± 3.0%, P = 0.017) and of poorly aerated lung tissue lower (9.5 ± 3.3 versus 15.7 ± 3.5%, P = 0.002) compared with control. EVA ventilation improves lung aeration via elevated mean tracheal pressure and consequently improves arterial oxygenation at unaltered positive end-expiratory pressure (PEEP) and peak inspiratory pressure (PIP). These findings suggest the EVA mode is a new approach for protective lung ventilation.