Effect of neuromuscular blocking agents on gas exchange in patients presenting with acute respiratory distress syndrome
Effect of neuromuscular blocking agents on gas exchange in patients presenting with acute respiratory distress syndrome
复制标题
DOI：
10.1097/01.ccm.0000104114.72614.bc
复制
发表时间：
2004-01-01
影响因子：
8.8
通讯作者：
Papazian, L
中科院分区：
文献类型：
--
作者：
Gainnier, M;Roch, A;Papazian, L
目的：评估 48 小时神经肌肉阻滞剂 (NMBA) 输注对急性呼吸窘迫综合征患者 120 小时内气体交换的影响。设计：多中心、前瞻性、对照和随机试验。设置：四个成人内科或混合内外科重症监护病房。患者：总共 56 名急性呼吸窘迫综合征患者，Pao(2)/FIo(2) 比值 < 150（阳性）呼气末压力大于或等于 5 cm H2O。 干预措施：随机分组后，患者在接下来的 48 小时内接受不含 NMBA 的常规治疗（对照组）或常规治疗加 NMBA。最初的呼吸机模式是容量辅助/控制。在最初的 48 小时内，两组呼吸机均保持辅助控制模式。潮气量为 6-8 mL/kg 理想体重。 测量和主要结果： 当分析整个 120 小时时，NMBA 对 Pao(2)/FIo(2) 比率的过程有显着影响 (p = .021)。每个时间点的单独比较表明，随机分配到 NMBA 组的患者在随机分配后 48、96 和 120 小时时具有较高的 Pao(2)/FIo(2)。此外，仅在 NMBA 组中发现呼气末正压下降 (p = .036)。双向重复测量方差分析显示呼气末正压随时间推移而下降 (p = .036)。关于短期效果，两组随机分组后 1 小时 Pao(2)/FIo(2) 比率均未发生变化。只有一名患者（来自对照组）出现气胸。结论：急性呼吸窘迫综合征患者在 48 小时内使用 NMBA 与氧合的持续改善相关。
Objective: To evaluate the effects of a 48-hr neuromuscular blocking agents (NMBA) infusion on gas exchange over a 120-hr time period in patients with acute respiratory distress syndrome.Design: Multiple center, prospective, controlled, and randomized trial.Setting: Four adult medical or mixed medical-surgical intensive care units.Patients: A total of 56 patients with acute respiratory distress syndrome with a Pao(2)/FIo(2) ratio of < 150 at a positive end-expiratory pressure of greater than or equal to 5 cm H2O.Interventions: After randomization, patients received either conventional therapy without NMBA (control group) or conventional therapy plus NMBA for the next 48 hrs. The initial ventilator mode was volume-assist/control. The ventilator remained on assist-control mode throughout the initial 48-hr period in both groups. Tidal volume was 6-8 mL/kg ideal body weight.Measurements and Main Results: When analyzed for the entire 120 hrs, there was a significant effect of the NMBA on the course of Pao(2)/FIo(2) ratio (p = .021). Separate comparisons at each time point indicated that patients randomized to the NMBA group had a higher Pao(2)/FIo(2) at 48, 96, and 120 hrs after randomization. Moreover, a decrease of positive end-expiratory pressure (p = .036) was only found in the NMBA group. Two-way repeated-measures analysis of variance exhibited a decrease in positive end-expiratory pressure over time (p = .036). Concerning short-term effects, there was no modification of Pao(2)/FIo(2) ratio 1 hr after randomization in either group. Only one patient (from the control group) developed pneumothorax.Conclusions: Use of NMBA during a 48-hr period in patients with acute respiratory distress syndrome is associated with a sustained improvement in oxygenation.