THERAPEUTIC OPTIMIZATION INCLUDING INHALED NITRIC-OXIDE IN ADULT-RESPIRATORY-DISTRESS-SYNDROME IN A POLYVALENT INTENSIVE-CARE UNIT
THERAPEUTIC OPTIMIZATION INCLUDING INHALED NITRIC-OXIDE IN ADULT-RESPIRATORY-DISTRESS-SYNDROME IN A POLYVALENT INTENSIVE-CARE UNIT
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DOI：
10.1097/00005373-199503000-00013
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发表时间：
1995-03-01
影响因子：
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通讯作者：
LARCAN, A
中科院分区：
文献类型：
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作者：
LEVY, B;BOLLAERT, PE;LARCAN, A
目的：研究吸入一氧化氮（NO）在成人呼吸窘迫综合征（ARDS）与氧参数，气压伤，并在内科和外科重症监护室演变的治疗优化策略的影响。设计：前瞻性研究。材料和方法：20例连续的ARDS患者进行了研究（Murray评分3.6 +/- 0.2）。11名是外科病人，9名是内科病人。所有患者均符合体外膜肺氧合入选标准。APACHE II评分预测死亡率为39%。所有患者均采用FiO（2）1通气，呼气末正压（PEEP）为11 +/- 1 cm H2O。治疗优化包括允许性高碳酸血症、气管充气、俯卧位、连续血液滤过、感染治疗和胸腔引流。我们使用浓度范围为5 - 10 ppm的NO持续吸入。测量和主要结果：1小时后，吸入NO改善了所有患者的PaO 2，只有一名患者除外（78 +/- 11至130 +/- 25 mm Hg）（p < 0.05），允许FiO（2）和PEEP降低。24小时后，平均肺动脉压从31 +/- 3降至25 +/- 2 mm Hg（p < 0.05）。全身血流动力学未受影响。氧输送从531 +/- 135增加到603 +/- 125 mL/min/m（-2）（p < 0.05）。仅1例患者出现气压创伤性病变。在16例患者中获得了ARDS的恢复，其中14例（70%）出院。结论：本研究时间较短，以证明生存率的提高。尽管如此，这些初步结果令人鼓舞。由于其安全性，有效性和易于使用，吸入NO应作为治疗优化方案的一部分，然后再考虑更具侵入性和昂贵的程序，如体外呼吸支持或血管内氧合。
Objective: To investigate the effects of inhaled nitric oxide (NO) in adult respiratory distress syndrome (ARDS) associated with a therapeutic optimization strategy on oxygen parameters, barotrauma, and evolution in a medical and surgical intensive care unit.Design: Prospective study.Materials and Methods: Twenty consecutive patients with ARDS were studied (Murray score 3.6 +/- 0.2). Eleven were surgical patients and nine were medical patients. All fulfilled the extracorporeal membrane oxygenation entry criteria. The APACHE II score predicted mortality was 39%. All were ventilated with FiO(2) 1 with positive end-expiratory pressure (PEEP) of 11 +/- 1 cm H2O. Therapeutic optimization included permissive hypercapnia, tracheal gas insufflation, prone position, continuous hemofiltration, treatment of infection, and pleural drainage. We used NO continuously inhaled at a concentration ranging from 5 to 10 ppm.Measurements and Main Results: After 1 hour, inhaled NO improved PaO2 in all patients except one (78 +/- 11 to 130 +/- 25 mm Hg)(p < 0.05), allowing a reduction of FiO(2) and PEEP. After 24 hours, mean pulmonary arterial pressure decreased from 31 +/- 3 to 25 +/- 2 mm Hg (p < 0.05). Systemic hemodynamics were unaffected. Oxygen delivery increased from 531 +/- 135 to 603 +/- 125 mL/minute/m(-2) (p < 0.05). Barotraumatic lesions were present in only one patient. Reversal of ARDS was obtained in 16 patients, of whom 14 (70%) were discharged.Conclusions: This study was shorter to demonstrate an improvement in the survival rate. Nevertheless, these preliminary results are encouraging. Because of its safety, effectiveness, and easy use, inhaled NO should be used as a part of a therapeutic optimization protocol before considering more invasive and expensive procedures, such as extracorporeal respiratory support or intravascular oxygenation.