A randomised controlled trial of an open lung strategy with staircase recruitment, titrated PEEP and targeted low airway pressures in patients with acute respiratory distress syndrome.
A randomised controlled trial of an open lung strategy with staircase recruitment, titrated PEEP and targeted low airway pressures in patients with acute respiratory distress syndrome.
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DOI：
10.1186/cc10249
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Nichol AD
中科院分区：
文献类型：
--
作者：
Hodgson CL;Tuxen DV;Davies AR;Bailey MJ;Higgins AM;Holland AE;Keating JL;Pilcher DV;Westbrook AJ;Cooper DJ;Nichol AD
潮气量和平台压最小化是急性呼吸窘迫综合征（ARDS）患者保护性肺通气策略的标准组成部分。开放肺策略，包括更高的呼气末正压（PEEP）和招募策略，迄今为止尚未证明有效。本研究检查了一种新的开放肺策略的有效性和安全性，该策略包括允许性高碳酸血症、阶梯复张策略（SRM）和低气道压伴PEEP滴定。20例ARDS患者随机接受治疗或ARDSnet控制通气策略。治疗组采用SRM，PEEP递减，目标平台压< 30 cm H2O。每天测量气体交换和肺顺应性，持续7天，并在前24小时和第1、3、5和7天测量血浆细胞因子（平均值± SE）。确定了通气时间、ICU住院时间和住院时间（中位数和四分位数间距）以及住院生存率。当考虑血浆IL-8和TNF-α时，组间存在显著的总体差异。对于血浆IL-8，对照组在7天内比治疗组高41%（比值1.41（1.11至1.79），P = 0.01），而对于TNF-α，对照组在7天内比治疗组高20%（比值1.20（1.01至1.42），P = 0.05）。治疗组PaO 2/FIO 2（204 ± 9 vs 165 ± 9 mmHg，P = 0.005）和静态肺顺应性（49.1 ± 2.9 vs 33.7 ± 2.7 mls/cm H2O，P < 0.001）均高于对照组。通气持续时间无差异（180（87至298）对341（131至351）小时，P = 0.13），ICU停留时间（9.9（5.6至14.8）与16.0（8.1至19.3）天，P = 0.19）和住院时间（17.9（13.7至34.5）vs 24.7（20.5至39.8）天，P = 0.16）。这种开放肺策略与7天内一些全身性细胞因子的更大改善、氧合和肺顺应性的改善相关。一个更大的试验，检查有临床意义的结果是必要的。ACTRN12607000465459
Tidal volume and plateau pressure minimisation are the standard components of a protective lung ventilation strategy for patients with acute respiratory distress syndrome (ARDS). Open lung strategies, including higher positive end-expiratory pressure (PEEP) and recruitment manoeuvres to date have not proven efficacious. This study examines the effectiveness and safety of a novel open lung strategy, which includes permissive hypercapnia, staircase recruitment manoeuvres (SRM) and low airway pressure with PEEP titration. Twenty ARDS patients were randomised to treatment or ARDSnet control ventilation strategies. The treatment group received SRM with decremental PEEP titration and targeted plateau pressure < 30 cm H2O. Gas exchange and lung compliance were measured daily for 7 days and plasma cytokines in the first 24 hours and on days 1, 3, 5 and 7 (mean ± SE). Duration of ventilation, ICU stay and hospital stay (median and interquartile range) and hospital survival were determined. There were significant overall differences between groups when considering plasma IL-8 and TNF-α. For plasma IL-8, the control group was 41% higher than the treatment group over the seven-day period (ratio 1.41 (1.11 to 1.79), P = 0.01), while for TNF-α the control group was 20% higher over the seven-day period (ratio 1.20 (1.01 to 1.42) P = 0.05). PaO2/FIO2 (204 ± 9 versus 165 ± 9 mmHg, P = 0.005) and static lung compliance (49.1 ± 2.9 versus 33.7 ± 2.7 mls/cm H2O, P < 0.001) were higher in the treatment group than the control group over seven days. There was no difference in duration of ventilation (180 (87 to 298) versus 341 (131 to 351) hrs, P = 0.13), duration of ICU stay (9.9 (5.6 to 14.8) versus 16.0 (8.1 to 19.3) days, P = 0.19) and duration of hospital stay (17.9 (13.7 to 34.5) versus 24.7 (20.5 to 39.8) days, P = 0.16) between the treatment and control groups. This open lung strategy was associated with greater amelioration in some systemic cytokines, improved oxygenation and lung compliance over seven days. A larger trial powered to examine clinically-meaningful outcomes is warranted. ACTRN12607000465459
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影响因子：
8.8
作者：
Lim, SC;Adams, AB;Marini, JJ
通讯作者：
Marini, JJ
影响因子：
120.7
作者：
Mercat, Alain;Richard, Jean-Christophe M.;Brochard, Laurent
通讯作者：
Brochard, Laurent
影响因子：
158.5
作者：
Amato, MBP;Barbas, CSV;Carvalho, CRR
通讯作者：
Carvalho, CRR
DOI：
10.1164/rccm.200205-394oc
发表时间：
2004-01-01
影响因子：
24.7
作者：
Laffey, JG;Honan, D;McLoughlin, P
通讯作者：
McLoughlin, P
影响因子：
8.8
作者：
通讯作者：
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