Heliox reduces respiratory system resistance in respiratory syncytial virus induced respiratory failure
Heliox reduces respiratory system resistance in respiratory syncytial virus induced respiratory failure
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DOI：
10.1186/cc7880
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发表时间：
2009-01-01
期刊：
影响因子：
15.1
通讯作者：
Markhors, Dick G.
中科院分区：
文献类型：
--
作者：
Kneyber, Martin C. J.;van Heerde, Marc;Markhors, Dick G.
呼吸道合胞病毒（RSV）下呼吸道疾病的特征是气道狭窄，导致气道阻力增加、空气潴留和呼吸性酸中毒。使用氦氧混合气体可以克服这些问题。然而，heliox机械通气对这些患者的影响尚不清楚。这项前瞻性交叉研究的目的是确定heliox 60/40机械通气与常规气体在呼吸系统阻力、空气捕获和二氧化碳去除方面的影响。方法对经证实的呼吸道合胞病毒患儿进行机械通气、镇静和瘫痪，并在患儿入住儿科重症监护病房（PICU）后24小时内进行统计。在T = 0时，使用AVEA呼吸机测量呼吸系统力学，包括呼吸系统顺应性和阻力，以及呼气峰值流速。每隔一段时间（heliox通气30分钟后，用氮气通气30分钟后，再用heliox通气30分钟后）重复测量。计算各时段的气体交换指数（通气量和氧合指数）。在每个间隔通过电阻抗断层扫描（EIT）确定空气捕获（由呼气末肺体积的相对变化定义）。结果13名婴儿入组。其中9例进行了EIT测量。螺旋机械通气显著降低呼吸系统阻力。这并不伴随着二氧化碳消除的改善，呼气峰流速的降低或呼气末肺体积的减少。重要的是，在整个实验过程中，氧合作用保持不变。结论螺旋机械通气可显著降低呼吸系统阻力
Introduction Respiratory syncytial virus (RSV) lower respiratory tract disease is characterised by narrowing of the airways resulting in increased airway resistance, air-trapping and respiratory acidosis. These problems might be overcome using helium-oxygen gas mixture. However, the effect of mechanical ventilation with heliox in these patients is unclear. The objective of this prospective cross-over study was to determine the effects of mechanical ventilation with heliox 60/40 versus conventional gas on respiratory system resistance, air-trapping and CO2 removal.Methods Mechanically ventilated, sedated and paralyzed infants with proven RSV were enrolled within 24 hours after paediatric intensive care unit (PICU) admission. At T = 0, respiratory system mechanics including respiratory system compliance and resistance, and peak expiratory flow rate were measured with the AVEA ventilator. The measurements were repeated at each interval (after 30 minutes of ventilation with heliox, after 30 minutes of ventilation with nitrox and again after 30 minutes of ventilation with heliox). Indices of gas exchange (ventilation and oxygenation index) were calculated at each interval. Air-trapping (defined by relative change in end-expiratory lung volume) was determined by electrical impedance tomography (EIT) at each interval.Results Thirteen infants were enrolled. In nine, EIT measurements were performed. Mechanical ventilation with heliox significantly decreased respiratory system resistance. This was not accompanied by an improved CO2 elimination, decreased peak expiratory flow rate or decreased end-expiratory lung volume. Importantly, oxygenation remained unaltered throughout the experimental protocol.Conclusions Respiratory system resistance is significantly decreased by mechanical ventilation with heliox