EARLY APPLICATION OF POSITIVE END-EXPIRATORY PRESSURE IN PATIENTS AT RISK FOR THE ADULT RESPIRATORY-DISTRESS SYNDROME
EARLY APPLICATION OF POSITIVE END-EXPIRATORY PRESSURE IN PATIENTS AT RISK FOR THE ADULT RESPIRATORY-DISTRESS SYNDROME
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DOI：
10.1056/nejm198408023110502
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发表时间：
1984-01-01
影响因子：
158.5
通讯作者：
CARRICO, CJ
中科院分区：
文献类型：
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作者：
PEPE, PE;HUDSON, LD;CARRICO, CJ
早期应用呼气末正压通气（PEEP）可能降低成人呼吸窘迫综合征的发生率。已知有该综合征风险的患者（92例）接受机械通气，要么没有PEEP（对照组），要么在8 cm H2O处有早期PEEP。这些治疗持续72小时，除非在24小时或更晚出现呼吸窘迫或动脉O2浓度高于140（分数吸气O2浓度，0.5），并在去除PEEP后保持在该水平。该研究被设计为有80%的概率检测到综合症发生率降低60%。治疗组在年龄、损伤严重程度、成人呼吸窘迫综合征危险因素的数量和类型以及初始氧合方面具有可比性。44例给予早期PEEP的患者中有11例（25%）出现该综合征，48例对照患者中有13例（27%）出现该综合征。两组的肺不张、肺炎和气压创伤发生率相同，死亡率也相同。高危患者在8cm H2O处早期应用PEEP对成人呼吸窘迫综合征及其他相关并发症的发生率无影响。
The early application of positive end-expiratory pressure (PEEP) possibly reduces the incidence of the adult respiratory-distress syndrome. Patients (92) with a known risk for this syndrome received mechanical ventilation either without PEEP (control) or with early PEEP at 8 cm H2O. These therapies continued for 72 h unless respiratory distress developed or arterial O2 tension was above 140 (fractional inspired O2 concentration, 0.5) at 24 h or later and remained at that level after removal of PEEP. The study was designed to have an 80% probability of detecting a 60% reduction in the incidence of the syndrome. The treatment groups were comparable in age, severity of injury, number and type of risk factors for adult respiratory-distress syndrome and initial oxygenation. The syndrome developed in 11 of 44 patients given early PEEP (25%) and in 13 of 48 control patients (27%). The incidence of atelectasis, pneumonia and barotrauma was the same in both groups, as was mortality. The early application of PEEP at 8 cm H2O in high-risk patients had no effect on the incidence of the adult respiratory-distress syndrome or other, associated complications.