Effect of regulating airway pressure on intrathoracic pressure and vital organ perfusion pressure during cardiopulmonary resuscitation: a non-randomized interventional cross-over study.
Effect of regulating airway pressure on intrathoracic pressure and vital organ perfusion pressure during cardiopulmonary resuscitation: a non-randomized interventional cross-over study.
复制标题
DOI：
10.1186/s13049-015-0164-5
复制
发表时间：
2015-10-28
期刊：
影响因子：
--
通讯作者：
Lurie K
中科院分区：
文献类型：
--
作者：
Kwon Y;Debaty G;Puertas L;Metzger A;Rees J;McKnite S;Yannopoulos D;Lurie K
本研究的目的是评估标准和胸内压力调节（IPR）辅助心肺复苏（CPR）过程中胸内压（Ppl）、气道压（Paw）和重要器官灌注压的变化。评估了多种CPR干预措施，包括基于IPR的新干预措施，IPR是一种在每次正压呼吸后增强胸内负压的治疗方法。八只麻醉的猪经历4分钟的未经处理的心室纤颤，随后进行2分钟的每个顺序干预：（1）常规标准CPR（STD），（2）自动主动加压减压（ACD）CPR，（3）ACD+阻抗阈值装置（ITD）CPR或（4）ACD+胸内压力调节器（ITPR）CPR，后两者代表基于IPR的CPR疗法。在每次CPR干预期间，测量并比较胸膜内压（Ppl）、气道压（Paw）、右心房压、颅内压和主动脉压沿着颈动脉血流量和潮气末CO2。最低的平均值和减压阶段Ppl观察到与基于IPR的治疗[Ppl平均值（平均值± SE）：STD（0.8 ± 1.1 mmHg）; ACD（−1.6 ± 1.6）; ACD-ITD（−3.7 ± 1.5，p < 0.05 vs. STD和ACD）; ACD-ITPR（−7.0 ± 1.9，p < 0.05 vs. STD和ACD）] [Ppl减压（平均值± SE）：STD（−6.3 ± 2.2）; ACD（−13.0 ± 3.8）; ACD-ITD −16.9 ± 3.6，p < 0.05 vs. STD和ACD）; ACD-ITPR −18.7 ± 3.5，p < 0.05 vs. STD和ACD）]。具有较低平均值或减压阶段Ppl的干预也证明了较低的Paw，并且与较高的重要器官灌注压相关。基于IPR的CPR方法，特别是ACD-ITPR，在Ppl和Paw中产生了最明显的减少，并且在CPR期间产生了最有利的血液动力学增强。本文的在线版本（doi：10.1186/s13049-015-0164-5）包含补充材料，可供授权用户使用。
The objective of this investigation was to evaluate changes in intrathoracic pressure (Ppl), airway pressure (Paw) and vital organ perfusion pressures during standard and intrathoracic pressure regulation (IPR)-assisted cardiopulmonary resuscitation (CPR). Multiple CPR interventions were assessed, including newer ones based upon IPR, a therapy that enhances negative intrathoracic pressure after each positive pressure breath. Eight anesthetized pigs underwent 4 min of untreated ventricular fibrillation followed by 2 min each of sequential interventions: (1) conventional standard CPR (STD), (2) automated active compression decompression (ACD) CPR, (3) ACD+ an impedance threshold device (ITD) CPR or (4) ACD+ an intrathoracic pressure regulator (ITPR) CPR, the latter two representing IPR-based CPR therapies. Intrapleural (Ppl), airway (Paw), right atrial, intracranial, and aortic pressures, along with carotid blood flow and end tidal CO2, were measured and compared during each CPR intervention. The lowest mean and decompression phase Ppl were observed with IPR-based therapies [Ppl mean (mean ± SE): STD (0.8 ± 1.1 mmHg); ACD (−1.6 ± 1.6); ACD-ITD (−3.7 ± 1.5, p < 0.05 vs. both STD and ACD); ACD-ITPR (−7.0 ± 1.9, p < 0.05 vs. both STD and ACD)] [Ppl decompression (mean ± SE): STD (−6.3 ± 2.2); ACD (−13.0 ± 3.8); ACD-ITD −16.9 ± 3.6, p < 0.05 vs. both STD and ACD); ACD-ITPR −18.7 ± 3.5, p < 0.05 vs. both STD and ACD)]. Interventions with the lower mean or decompression phase Ppl also demonstrated lower Paw and were associated with higher vital organ perfusion pressures. IPR-based CPR methods, specifically ACD-ITPR, yielded the most pronounced reduction in both Ppl and Paw and resulted in the most favorable augmentation of hemodynamics during CPR. The online version of this article (doi:10.1186/s13049-015-0164-5) contains supplementary material, which is available to authorized users.