Ventilation strategies for front of neck airway rescue: an in silico study.
Ventilation strategies for front of neck airway rescue: an in silico study.
复制标题
颈前气道救援的通气策略：一项计算机研究。
DOI：
10.1016/j.bja.2021.01.030
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发表时间：
2021
影响因子：
9.8
通讯作者：
Laviola M
中科院分区：
文献类型：
--
作者：
Laviola M
背景在全麻诱导过程中，可能出现“无法插管，无法插管”（CICO）的情况，导致严重的低氧血症。证据是稀缺的，以指导小口径的紧急前颈部气道，确保有效的氧合作用，而不冒肺损伤和心血管depression.MethodsFifty虚拟主题配置使用高保真计算模型的心血管和肺系统的通气策略。每例受试者呼吸100%氧气3分钟，然后出现呼吸暂停，上气道阻塞。当动脉血红蛋白氧饱和度达到40%时，用各种配置模拟颈前气道通路。我们研究了几种通气策略对再氧合，肺动脉压，心血管功能和氧delivery.ResultsReoxygenation的影响，在所有的通气策略实现。较小的气道配置导致动态过度充气的广泛的通气策略。在内径较大（≥3 mm）的气道中不存在这种效应。最小气道的肺内压迅速升高至超生理值，导致明显的心循环抑制（心输出量<3 L min− 1，平均动脉压<60 mm Hg），阻碍氧气输送（<600 ml min−1）。限制潮气量（≤200 ml）和呼吸频率（≤8 bpm）为较小的直径插管减少动态过度充气和气体截留，防止心血管depressation.ConclusionsDynamic过度充气可以证明为一个广泛的颈部前气道插管时，上气道阻塞。在CICO情况下使用小口径插管时，应选择防止气体滞留的通气策略，以防止严重不良事件，包括心循环抑制。
BackgroundDuring induction of general anaesthesia a ‘cannot intubate, cannot oxygenate’ (CICO) situation can arise, leading to severe hypoxaemia. Evidence is scarce to guide ventilation strategies for small-bore emergency front of neck airways that ensure effective oxygenation without risking lung damage and cardiovascular depression.MethodsFifty virtual subjects were configured using a high-fidelity computational model of the cardiovascular and pulmonary systems. Each subject breathed 100% oxygen for 3 min and then became apnoeic, with an obstructed upper airway. When arterial haemoglobin oxygen saturation reached 40%, front of neck airway access was simulated with various configurations. We examined the effect of several ventilation strategies on re-oxygenation, pulmonary pressures, cardiovascular function, and oxygen delivery.ResultsRe-oxygenation was achieved in all ventilation strategies. Smaller airway configurations led to dynamic hyperinflation for a wide range of ventilation strategies. This effect was absent in airways with larger internal diameter (≥3 mm). Intrapulmonary pressures increased quickly to supra-physiological values with the smallest airways, resulting in pronounced cardio-circulatory depression (cardiac output <3 L min−1and mean arterial pressure <60 mm Hg), impeding oxygen delivery (<600 ml min−1). Limiting tidal volume (≤200 ml) and ventilatory frequency (≤8 bpm) for smaller diameter cannulas reduced dynamic hyperinflation and gas trapping, preventing cardiovascular depression.ConclusionsDynamic hyperinflation can be demonstrated for a wide range of front of neck airway cannulae when the upper airway is obstructed. When using small-bore cannulae in a CICO situation, ventilation strategies should be chosen that prevent gas trapping to prevent severe adverse events including cardio-circulatory depression.
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