Lung recruitment manoeuvres are effective in regaining lung volume and oxygenation after open endotracheal suctioning in acute respiratory distress syndrome.
Lung recruitment manoeuvres are effective in regaining lung volume and oxygenation after open endotracheal suctioning in acute respiratory distress syndrome.
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DOI：
10.1186/cc1844
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发表时间：
2003-02
期刊：
影响因子：
--
通讯作者：
Larsson A
中科院分区：
文献类型：
--
作者：
Dyhr T;Bonde J;Larsson A
急性肺损伤和急性呼吸窘迫综合征患者在开放气管内吸引术(ETS)后出现低氧血症，肺萎陷是其诱因之一。肺复张(LR)动作在ETS后快速恢复肺容量和改善氧合方面可能是有效的。一项前瞻性、随机、对照研究在一所大学医院的15张病床的普通重症监护室进行。纳入连续8例机械通气的急性肺损伤或急性呼吸窘迫综合征患者。每个患者都接受了两种吸引术中的一种。在第一个程序中，进行ETS，然后进行LR操作并重新连接到呼吸机，呼气末正压设置在下拐点上方1cmH2O，60min后再次进行ETS(但不进行LR操作)，然后重新连接到呼气末正压相似的呼吸机；第二个程序与第一个相同，但操作顺序相反。分别于术前(基线)和术后25min以上测定动脉血氧分压(PaO2)和呼气末肺活量。治疗后动脉血氧分压下降4.3kPa0.9~9.7kPaP<；0.005。下丘脑下移动作后，PaO2恢复到基线水平。在无LR动作的情况下，动脉血氧分压下降(P=0.05)，直到ETS后7min。而无LR动作时，ETS后5分钟和15分钟呼气末肺活量仍减少约10%(P=0.01)。在接受呼吸机治疗的急性肺损伤或急性呼吸窘迫综合征患者中，在ETS后立即进行LR动作作为呼气末正压的辅助，有效地快速对抗开放ETS引起的PaO2和肺容量的恶化。
Lung collapse is a contributory factor in the hypoxaemia that is observed after open endotracheal suctioning (ETS) in patients with acute lung injury and acute respiratory distress syndrome. Lung recruitment (LR) manoeuvres may be effective in rapidly regaining lung volume and improving oxygenation after ETS. A prospective, randomized, controlled study was conducted in a 15-bed general intensive care unit at a university hospital. Eight consecutive mechanically ventilated patients with acute lung injury or acute respiratory distress syndrome were included. One of two suctioning procedures was performed in each patient. In the first procedure, ETS was performed followed by LR manoeuvre and reconnection to the ventilator with positive end-expiratory pressure set at 1 cmH2O above the lower inflexion point, and after 60 min another ETS (but without LR manoeuvre) was performed followed by reconnection to the ventilator with similar positive end-expiratory pressure; the second procedure was the same as the first but conducted in reverse order. Before (baseline) and over 25 min following each ETS procedure, partial arterial oxygen tension (PaO2) and end-expiratory lung volume were measured. After ETS, PaO2 decreased by 4.3(0.9–9.7)kPa (median and range; P < 0.005). After LR manoeuvre, PaO2 recovered to baseline. Without LR manoeuvre, PaO2 was reduced (P = 0.05) until 7 min after ETS. With LR manoeuvre end-expiratory lung volume was unchanged after ETS, whereas without LR manoeuvre end-expiratory lung volume was still reduced (approximately 10%) at 5 and 15 min after ETS (P = 0.01). A LR manoeuvre immediately following ETS was, as an adjunct to positive end-expiratory pressure, effective in rapidly counteracting the deterioration in PaO2 and lung volume caused by open ETS in ventilator-treated patients with acute lung injury or acute respiratory distress syndrome.
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影响因子：
3.3
作者：
Neumann, P;Berglund, JE;Hedenstierna, G
通讯作者：
Hedenstierna, G
影响因子：
38.9
作者：
Cereda, M;Villa, F;Pesenti, A
通讯作者：
Pesenti, A
影响因子：
8.8
作者：
LARSSON, A;LINNARSSON, D;WERNER, O
通讯作者：
WERNER, O
DOI：
10.1164/ajrccm.159.4.9801088
发表时间：
1999-04-01
影响因子：
24.7
作者：
Jonson, B;Richard, JC;Brochard, L
通讯作者：
Brochard, L
DOI：
10.1164/ajrccm/144.2.395
发表时间：
1991-08-01
期刊：
AMERICAN REVIEW OF RESPIRATORY DISEASE
影响因子：
--
作者：
BROCHARD, L;MION, G;HARF, A
通讯作者：
HARF, A