Recruitment maneuvers attenuate repeated derecruitment-associated lung injury
Recruitment maneuvers attenuate repeated derecruitment-associated lung injury
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DOI：
10.1097/01.ccm.0000162909.05340.ae
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发表时间：
2005-05-01
影响因子：
8.8
通讯作者：
Kwon, OJ
中科院分区：
文献类型：
--
作者：
Koh, WJ;Suh, GY;Kwon, OJ
目标。反复拔除先前招募的肺可加重机械通气过程中的肺损伤。设计：前瞻性、随机、实验动物研究。地点：大学实验室。研究对象：新西兰大白兔。干预：21只新西兰大白兔在恒定潮气量(10毫升/公斤)下进行压力控制模式的呼吸机。反复生理盐水灌洗致肺损伤后，在较低拐点给予呼气末正压(PEEP)3h。对照组(n=7)在相同的呼气末呼气末呼气末正压(PEEP)下进行3h的机械通气。脱机组(n=7)，每隔10min故意切断呼吸机回路1min，连续3h，反复进行脱机。复张手法组(n=7)，每次拔管后持续正压30cmH2O 30s。在提高PEEP水平以降低拐点后，所有组的PaO(2)均升高至500 mm Hg。动脉血氧分压升高(2)在控制组和复苏组持续在450 mm HgHg2小时和3小时观察到动脉血氧水平的进行性下降(中位数，381.1 mm Hg[四分位数范围，350.1-466.7 mm Hg]和318.2 mm Hg[214.3-414.9 mm Hg]，p
Objective. Repeated derecruitments of previously recruited lungs can exacerbate lung injuries during mechanical ventilation. The aim of this study was to assess lung injury associated with repeated derecruitments and to assess whether this type of injury could be attenuated by recruitment maneuvers.Design: Prospective, randomized, experimental animal study.Setting: University laboratory.Subjects: New Zealand White rabbits.Interventions: Twenty-one rabbits were ventilated in pressure-controlled mode with constant tidal volume (10 mL/kg). After lung injury was induced by repeated saline lavage, positive end-expiratory pressure (PEEP) at a lower inflection point was applied for 3 hrs. The control group (n = 7) received ventilation with the same PEEP for 3 hrs without derecruitments. In the derecruitment group (n = 7), derecruitment was repeatedly induced by intentional disconnection of the ventilatory circuit for 1 min every 10 mins for 3 hrs. In the recruitment maneuver group (n = 7), continuous positive airway pressure of 30 cm H2O was applied for 30 secs after each derecruitment.Measurements and Main Results. After PEEP levels were increased to lower the inflection point value, Pao(2) increased to > 500 mm Hg in all groups. Increased Pao(2) persisted at > 450 mm Hg in the control and recruitment maneuver groups, whereas progressive declines in arterial oxygen levels were observed in the derecruitment group (median, 381.1 mm Hg [interquartile range, 350.1-466.7 mm Hg] at 2 hrs and 318.2 mm Hg [214.3-414.9 mm Hg] at 3 hrs, p