The Comparison of Spontaneous Breathing and Muscle Paralysis in Two Different Severities of Experimental Lung Injury
The Comparison of Spontaneous Breathing and Muscle Paralysis in Two Different Severities of Experimental Lung Injury
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DOI：
10.1097/ccm.0b013e3182711972
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发表时间：
2013-02-01
影响因子：
8.8
通讯作者：
Fujino, Yuji
中科院分区：
文献类型：
--
作者：
Yoshida, Takeshi;Uchiyama, Akinori;Fujino, Yuji
目的：自主呼吸相对于肌肉麻痹的益处主要在轻度肺损伤中得到证实;尚未有人评估自主呼吸在重度肺损伤中的作用。我们研究了自主呼吸在两种不同严重程度的肺损伤与肌肉麻痹中的作用。设计：前瞻性、随机、动物研究。设置：大学动物研究实验室。受试者：28只新西兰白色兔。干预措施：将家兔随机分为轻度肺损伤组（表面活性剂耗竭）组或重度肺损伤（表面活性剂耗竭后进行损伤性机械通气）组和4-hr低潮气量通气伴自主呼吸或不伴自主呼吸（通过神经肌肉阻滞剂预防）。调整吸气压，将潮气量控制在5-7 mL/kg，维持平台压低于30 cm H2O。动态CT被用来评估肺通气和潮气量的区域分布的变化。测量和结果：在轻度肺损伤，自主呼吸改善氧合和肺通气潮气量的重新分配到依赖的肺区域。然而，在严重的肺损伤，自主呼吸引起肺不张与周期性塌陷显着增加。由于肺损伤的严重性，该组具有更高的平台压和更多的过度自主呼吸努力，导致最高的跨肺压和最高的驱动压。虽然没有观察到肺通气的改善，但严重肺损伤的肌肉麻痹导致更好的氧合，更均匀的潮气通气，和更少的组织学肺损伤。结论：在轻度肺损伤的动物中，自主呼吸有利于肺复张;然而，在严重肺损伤的动物中，自主呼吸可能会加重肺损伤，而肌肉麻痹可能通过防止损伤性的高跨肺压和高驱动压而对受伤的肺更有保护作用。(Crit Care Med 2013; 41：536-545）
Objectives: The benefits of spontaneous breathing over muscle paralysis have been proven mainly in mild lung injury; no one has yet evaluated the effects of spontaneous breathing in severe lung injury. We investigated the effects of spontaneous breathing in two different severities of lung injury compared with muscle paralysis.Design: Prospective, randomized, animal study.Setting: University animal research laboratory.Subjects: Twenty-eight New Zealand white rabbits.Interventions: Rabbits were randomly divided into the mild lung injury (surfactant depletion) group or severe lung injury (surfactant depletion followed by injurious mechanical ventilation) group and ventilated with 4-hr low tidal volume ventilation with spontaneous breathing or without spontaneous breathing (prevented by a neuromuscular blocking agent). Inspiratory pressure was adjusted to control tidal volume to 5-7 mL/kg, maintaining a plateau pressure less than 30 cm H2O. Dynamic CT was used to evaluate changes in lung aeration and the regional distribution of tidal volume.Measurements and Results: In mild lung injury, spontaneous breathing improved oxygenation and lung aeration by redistribution of tidal volume to dependent lung regions. However, in severe lung injury, spontaneous breathing caused a significant increase in atelectasis with cyclic collapse. Because of the severity of lung injury, this group had higher plateau pressure and more excessive spontaneous breathing effort, resulting in the highest transpulmonary pressure and the highest driving pressure. Although no improvements in lung aeration were observed, muscle paralysis with severe lung injury resulted in better oxygenation, more even tidal ventilation, and less histological lung injury.Conclusions: In animals with mild lung injury, spontaneous breathing was beneficial to lung recruitment; however, in animals with severe lung injury, spontaneous breathing could worsen lung injury, and muscle paralysis might be more protective for injured lungs by preventing injuriously high transpulmonary pressure and high driving pressure. (Crit Care Med 2013; 41: 536-545)