Pre-hospital continuous positive airway pressure after blast lung injury and hypovolaemic shock: a modelling study.
Pre-hospital continuous positive airway pressure after blast lung injury and hypovolaemic shock: a modelling study.
复制标题
爆炸性肺损伤和低血容量休克后院前持续气道正压通气：一项模型研究。
DOI：
10.1016/j.bja.2021.10.012
复制
发表时间：
2022
影响因子：
9.8
通讯作者：
Mistry S
中科院分区：
文献类型：
--
作者：
Mistry S
背景在非创伤性呼吸衰竭中，院前应用CPAP可减少插管的需要。原发性冲击波肺损伤（PBLI）合并失血性休克是大规模伤亡事件后常见的并发症。我们假设，院前CPAP也是有益的PBLI伴随出血shock.MethodsWe进行了基于计算机的模拟心肺反应PBLI出血，校准从出版的对照猪实验探索爆炸伤和出血性休克。在3例轻度、中度和重度PBLI（10%、25%和50%全肺挫伤）合并失血性休克的矽肺患者中模拟不同CPAP水平的效果。主要结果是动脉血氧分压（PaO 2）在每个simulation.ResultsIn轻度冲击伤肺，5厘米H2O环境空气CPAP increasedPaO 2从10.6至12.6 kPa结束。较高的CPAP并未进一步改善Pao 2。在中度冲击伤中，10 cm H2O CPAP使PaO 2增加较大（从8.5增加到11.1 kPa），但15 cm H2O CPAP没有进一步的益处。重度冲击伤时，5cm H_2O CPAP使PaO_2由4.06 kPa升至8.39 kPa。进一步增加CPAP到10-15厘米H2O reducedPao 2（7.99和7.90千帕，分别）作为结果的血流动力学损害导致增加intrathoracic pressure.ConclusionsOur建模研究表明，环境空气5厘米H2O CPAP可能有利于伤员遭受爆炸性肺损伤，甚至严重失血性休克。然而，重度肺损伤后，超过10 cm H2O的较高CPAP水平会因血流动力学损伤而减少氧输送。
BackgroundIn non-traumatic respiratory failure, pre-hospital application of CPAP reduces the need for intubation. Primary blast lung injury (PBLI) accompanied by haemorrhagic shock is common after mass casualty incidents. We hypothesised that pre-hospital CPAP is also beneficial after PBLI accompanied by haemorrhagic shock.MethodsWe performed a computer-based simulation of the cardiopulmonary response to PBLI followed by haemorrhage, calibrated from published controlled porcine experiments exploring blast injury and haemorrhagic shock. The effect of different CPAP levels was simulated in threein silicopatients who had sustained mild, moderate, or severe PBLI (10%, 25%, 50% contusion of the total lung) plus haemorrhagic shock. The primary outcome was arterial partial pressure of oxygen (Pao2) at the end of each simulation.ResultsIn mild blast lung injury, 5 cm H2O ambient-air CPAP increasedPao2from 10.6 to 12.6 kPa. Higher CPAP did not further improvePao2. In moderate blast lung injury, 10 cm H2O CPAP produced a larger increase inPao2(from 8.5 to 11.1 kPa), but 15 cm H2O CPAP produced no further benefit. In severe blast lung injury, 5 cm H2O CPAP inceasedPao2from 4.06 to 8.39 kPa. Further increasing CPAP to 10–15 cm H2O reducedPao2(7.99 and 7.90 kPa, respectively) as a result of haemodynamic impairment resulting from increased intrathoracic pressures.ConclusionsOur modelling study suggests that ambient air 5 cm H2O CPAP may benefit casualties suffering from blast lung injury, even with severe haemorrhagic shock. However, higher CPAP levels beyond 10 cm H2O after severe lung injury reduced oxygen delivery as a result of haemodynamic impairment.
登录
查看更多内容
影响因子：
9.8
作者：
Kirkman, E.;Watts, S.
通讯作者：
Watts, S.
院前持续气道正压通气（CPAP）治疗急性呼吸窘迫：一项随机对照试验
影响因子：
3.1
作者：
J. Finn;D. Brink;N. Mckenzie;Antón García;H. Tohira;G. Perkins;G. Arendts;D. Fatovich;D. Hendrie;B. McQuillan;Q. Summers;A. Celenza;Ashes Mukherjee;Ben Smedley;G. Pereira;S. Ball;T. Williams;P. Bailey
通讯作者：
P. Bailey
DOI：
10.1186/s13049-016-0315-3
发表时间：
2016-10-10
期刊：
Scandinavian journal of trauma, resuscitation and emergency medicine
影响因子：
--
作者：
Nielsen VM;Madsen J;Aasen A;Toft-Petersen AP;Lübcke K;Rasmussen BS;Christensen EF
通讯作者：
Christensen EF
颈前气道救援的通气策略：一项计算机研究。
影响因子：
9.8
作者：
Laviola M
通讯作者：
Laviola M