Intrathoracic pressure regulation improves 24-hour survival in a pediatric porcine model of hemorrhagic shock.
Intrathoracic pressure regulation improves 24-hour survival in a pediatric porcine model of hemorrhagic shock.
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DOI：
10.1203/pdr.0b013e3182275232
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发表时间：
2011-09
影响因子：
3.6
通讯作者：
Yannopoulos D
中科院分区：
文献类型：
--
作者：
Metzger A;Matsuura T;McKnite S;Marino BS;Nadkarni VM;Yannopoulos D
失血性休克是儿科人群死亡和发病的常见原因。胸内压调节(IPR)可降低胸内压，从而降低颅内压，增加静脉回流、心输出量和脑灌注量，而不需要立即进行液体复苏。我们假设IPR可以改善失血性休克的儿童猪模型的血流动力学和24小时存活率。20只仔猪在15分钟内经历了50%的总出血量的出血，然后随机分为IPR治疗组和不治疗组。60分钟后，幸存者接受自动输血，脱离呼吸机，并在24小时进行评估和尸检。记录平均动脉压(MAP)、心脏指数(CI)和动脉血气。IPR组平均动脉压(MAP)(60.8±3.7)显著高于对照组(41.2±4.6，P<0.01)。平均CI(L/分钟/m2)IPR组(3.9±0.2 4)显著高于对照组(2.5±0.39，P<0.0 1)。IPR组的IPR存活率显著提高(9/9(IPR)vs5/11(对照组)；p<；0.02)。在失血性休克的仔猪模型中，IPR治疗安全且显著提高了MAP、CI和24小时存活率。
Hemorrhagic shock is a common cause of mortality and morbidity in the pediatric population. Intrathoracic pressure regulation (IPR) lowers intrathoracic pressure thereby decreasing intracranial pressure and increasing venous return, cardiac output, and cerebral perfusion without the need for immediate fluid resuscitation. We hypothesized that IPR would improve hemodynamics and 24-hour survival in a pediatric porcine model of hemorrhagic shock. Twenty piglets were subjected to a 50% total blood volume hemorrhage over 15 minutes and then randomized to treatment with either IPR or no treatment. After 60 minutes, survivors were auto-transfused, weaned from the ventilator and assessed and autopsied at 24 hours. Mean arterial pressures (MAP), cardiac index (CI), and arterial blood gases were recorded. MAP (mmHg) was significantly higher in the IPR group (60.8 ± 3.7) vs. controls (41.2 ± 4.6, p<0.01). Mean CI (L/min/m2) was significantly higher with IPR (3.9 ± 0.24) vs. controls (2.5 ± 0.39, p<0.01). IPR survival rates were significantly improved with the IPR (9/9 (IPR) vs 5/11 (controls); p<0.02). In this piglet model of hemorrhagic shock, the IPR treatment safely and significantly improved MAP, CI and 24 hour survival rates.