Intratracheal pulmonary ventilation keeps tracheal tubes clean without impairing mucociliary transport.
Intratracheal pulmonary ventilation keeps tracheal tubes clean without impairing mucociliary transport.
复制标题
气管内肺通气可保持气管导管清洁，而不损害粘液纤毛运输。
DOI：
10.1080/00365510260296500
复制
发表时间：
2002
影响因子：
2.1
通讯作者：
Forcier,K
中科院分区：
文献类型：
--
作者：
Trawoger,R;Kolobow,T;Patroniti,N;Forcier,K
气管肺通气（ITPV）是一种通过反向推力导管进行气管气体注入的形式，有助于呼气和增强二氧化碳的去除。羊气管机械通气3天，通过逆推导管输送气体，无分泌物，无吸痰。假设：1)肺部的呼气流与反向导管的连续头流相结合，保持了气管内管的清洁；2)气管黏液速度不受ITPV影响。方法采用气管模型，经8mm气管内管与试验肺和呼吸机连接。在常规机械通气和ITPV下测量模型气管和气管内黏液的吸、呼气峰流速和黏液的运动。以钽盘为标记物，对7只经气管插管、采用容量控制通气和ITPV通气1小时的绵羊进行气管粘液流速的x线测量。将1毫升埃文斯蓝染料注入气管，观察粘液进入气管内管的情况。结果在ITPV过程中，呼气流速超过吸气峰值流速100%。在容积控制通风时，流速相等。在ITPV过程中，模型气管内黏液先缓慢后快速的头向运动，距离气管插管尖端0.5 cm，黏液进入气管插管后速度加快。在容积控制通气时，未发现粘液运动。在容量控制通气和ITPV期间，基线气管粘液流速相等。经Evans蓝染色的分泌物进入气管导管内，并迅速从气管导管内排出；在容量控制通气时，两只羊只发现了粘液的痕迹。结论ITPV术中呼气流量增强，通过气管导管尖端黏液夹带排出气管导管分泌物。气管黏液速度不受ITPV的影响。
BackgroundIntratracheal pulmonary ventilation (ITPV) is a form of tracheal gas insufflation through a reverse thrust catheter that facilitates expiration and enhances CO 2 removal. Tracheas of sheep mechanically ventilated for 3 days with gas delivered through the reverse-thrust catheter remained free of secretions, without suctioning. It was hypothesized that: 1) The expiratory flow from the lungs, combined with continuous cephalad flow from the reversethrust catheter keeps endotracheal tubes clean; and 2) tracheal mucus velocity is not impaired by ITPV.MethodsA model trachea connected to a test lung and to a ventilator, via an 8-mm endotracheal tube, was used. Inspiratory and expiratory peak flow velocities and the movement of mucus in the model trachea and in the endotracheal tube were measured during conventional mechanical ventilation and ITPV. Tracheal mucus velocity was measured radiographically, using tantalum discs as markers, in seven intubated sheep ventilated for one hour with volume-controlled ventilation, and with ITPV. One millilitre Evans Blue dye was introduced into the trachea, to visualize mucus transport into the endotracheal tube.ResultsPeak expiratory flow velocity exceeded peak inspiratory flow velocity by 100% during ITPV. During volume-controlled ventilation, flow velocities were equal. During ITPV, there was slow, then rapid cephalad movement of mucus in the model trachea, 0.5 cm distal to the tip of the endotracheal tube, the velocity increasing once mucus entered the endotracheal tube. During volume-controlled ventilation, no movement of mucus was found. Baseline tracheal mucus velocity was equal during volume-controlled ventilation and ITPV. Secretions stained with Evans Blue dye entered the endotracheal tube and were rapidly expelled from within the endotracheal tubes during ITPV; only traces of mucus were found in two sheep during volume-controlled ventilation.ConclusionThe enhanced expiratory flow during ITPV expels secretions from the endotracheal tube through entraining of mucus at the tip of the endotracheal tube. Tracheal mucus velocity is not influenced by ITPV.