VOLUME RECRUITMENT MANEUVERS ARE LESS DELETERIOUS THAN PERSISTENT LOW LUNG-VOLUMES IN THE ATELECTASIS-PRONE RABBIT LUNG DURING HIGH-FREQUENCY OSCILLATION
VOLUME RECRUITMENT MANEUVERS ARE LESS DELETERIOUS THAN PERSISTENT LOW LUNG-VOLUMES IN THE ATELECTASIS-PRONE RABBIT LUNG DURING HIGH-FREQUENCY OSCILLATION
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DOI：
10.1097/00003246-199303000-00019
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发表时间：
1993-03-01
影响因子：
8.8
通讯作者：
FROESE, AB
中科院分区：
文献类型：
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作者：
BOND, DM;FROESE, AB
目的：为了测试是否重复的容量招聘的肺风险是大于或小于与不可逆的肺不张相关的风险在6小时的高频振荡通气在肺不张倾向rabbit lung.Design：前瞻性，对照，随机比较超过6小时的呼吸机management.Setting. Laboratory.Subjects:28只成年新西兰白色雄性家兔（体重2.3 ~ 2.8 kg）。背景：对于在肺不张倾向肺中是否应使用高频振荡通气与容量复张操作，或在低平均和峰值压力下使用而不进行容量复张以避免甚至短暂性肺过度扩张的风险，存在争议。潜在的风险和好处伴随both alternatives.Interventions：我们评估了三个高频振荡通气协议在麻醉兔的肺的影响，使表面活性剂缺乏盐水灌洗，使用动物通气与传统的正压通气与呼气末正压作为参考组，每组n = 5。三组高频振荡通气组以15 Hz（900次/min）通气6 h，FIO 2 = 1.0。重复牵张组每20分钟接受30 cm H2O平均气道压15秒的持续充气，维持平均气道压足以保持PaO 2>350 mmHg（46.7 kPa）。重复放气组维持在PaO 2 70 - 120 kPa（9.3 - 16 kPa）的水平，每20分钟将气管内导管打开至大气压15秒。回缩后重复牵拉组中的动物按照重复牵拉方案进行管理，但每次持续充盈前先进行15秒回缩，以达到功能性残气量。常规正压通气组以30 - 100次/min的速率通气，保持PaO 2 70 - 120 kPa（9.3 - 16 kPa）。终点包括终端功能残气量和顺应性指数计算呼吸系统的压力-容量curve.Measurements和主要结果：6小时的通气后，呼吸系统的顺应性在重复拉伸组已恢复到控制值（1.35 +/- 0.18 [SD] cm H2O）。在重复放气组（0.89 +/- 0.08）和放气后重复牵拉组（1.24 +/- 0.22）中，呼吸系统顺应性显著低于该数值（p
Objectives: To test whether the pulmonary risk of repeated volume recruitment is greater or less than the risk associated with unreversed atelectasis during 6 hrs of high-frequency oscillatory ventilation in the atelectasis-prone rabbit lung.Design: Prospective, controlled, randomized comparison over 6 hrs of ventilator management.Setting. Laboratory.Subjects: Twenty-eight adult New Zealand white male rabbits (weight 2.3 to 2.8 kg).Background: Controversy exists over whether high-frequency oscillatory ventilation should be used with volume recruitment maneuvers in the atelectasis-prone lung, or be used at low mean and peak pressures without volume recruitment to avoid the risks of even transient pulmonary overdistention. Potential risks and benefits accompany both alternatives.Interventions: We evaluated the pulmonary effects of three high-frequency oscillatory ventilation protocols in anesthetized rabbits made surfactant deficient by saline lavage, using animals ventilated with conventional positive-pressure ventilation with positive end-expiratory pressure as a reference group; n = 5 in each group. The three high-frequency oscillatory ventilation groups were ventilated for 6 hrs at 15 Hz (900 breaths/min), FIO2 = 1.0. The repeated stretch group received 15-sec sustained inflations at 30 cm H2O mean airway pressure every 20 mins, with maintenance mean airway pressure sufficient to keep PaO2 >350 torr (46.7 kPa). The repeated deflation group was maintained at levels that produced PaO2 70 to 120 torr (9.3 to 16 kPa), with the endotracheal tube opened to atmospheric pressure for 15 secs every 20 mins. Animals in the repeated stretch after deflations group were managed as in the repeated stretch protocol but each sustained inflation was preceded by a 15-sec deflation to functional residual capacity. The conventional positive-pressure ventilation group was ventilated at rates of 30 to 100 breaths/min, keeping PaO2 70 to 120 torr (9.3 to 16 kPa). End-points included terminal functional residual capacity and a compliance index computed from respiratory system pressure-volume curves.Measurements and Main Results: After 6 hrs of ventilation, respiratory system compliance in the repeated stretch group had returned to control values (1.35 +/- 0.18 [SD] cm H2O). Respiratory system compliance was significantly less than this number in both the repeated deflation (0.89 +/- 0.08) and repeated stretch after deflations (1.24 +/- 0.22) groups (p