INTERVENTIONS TO PROMOTE VENTILATOR WEANING

促进呼吸机脱机的干预措施

• 批准号: 6539383
• 负责人: Kathleen S. Stone
• 金额: $ 36.33万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-09-30 至 2005-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6539383
• 关键词: autonomic nervous system; critical care nursing; disease /disorder model; diuresis; dogs; furosemide; heart failure; hemodynamics; method development; neurohormones; nitroferricyanide; nonhuman therapy evaluation; nursing intervention; pulmonary respiration; respirators; respiratory airway volume; respiratory disease /disorder therapy; respiratory disorder; respiratory therapy

DESCRIPTION (As Adapted from the Investigator's Abstract): Weaning the critically ill patient from mechanical ventilation (MV) to spontaneous ventilation (SpV) continues to be a significant challenge for nursing. It is estimated that 9-37% of mechanically ventilated patients have difficulty with the immediate transition from MV to SpV due to hemodynamic instability caused by pre-existing left ventricular dysfunction. The purpose of this study is to examine interventions to optimize the cardiopulmonary (CP) hemodynamic changes associated with the immediate transition from MV to SpV while comparing commonly used modes (t-piece, continuous positive airway press and pressure support) of spontaneous ventilation in canine subjects with and without heart failure. The specific aims are: 1) to compare the effects of preload at normovolemia and hypervolemia prior to and following diuresis with furosemide on CP hemodynamics during the transition from MV to SpV (T-piece, CPAP & PS) in normal canines (GI) and in heart failure (paced) canines (GII). 2) to compare CP hemodynamics prior to and following afterload reduction with nitroprusside during the transition from MV to SpV (T-piece, CPAP & PS) in GI and GII canines. 3) to determine whether CP hemodynamic changes associated with the transition from MV to SpV prior to and following diuresis or afterload reduction alter autonomic nervous system tone as reflected by heart rate variability in GI ad GII canines. The sample will consist of 116 canines randomly assigned to GI or GII. The GII canines will undergo pacemaker insertion and pacing for 7 weeks to produce a tachycardic chronic congestive heart failure. Under anesthesia, he subjects will be instrumented with state of the art biotechnology including a right ventricular ejection fraction pulmonary artery catheter and a Millar micromanometer pressure catheter to measure right ventricular function and a conductance catheter and Miller micromanometer pressure catheter to measure left ventricular function continuously. The data will be analyzed using repeated measures multivariate analysis of variance. The results of this study will provide insight into methods of optimizing cardiovascular function and the selection of an appropriate mode of spontaneous ventilation based on cardiovascular status that can be later tested in a randomized controlled trial in humans.

描述（改编自研究者摘要）：断奶 危重患者从机械通气（MV）转为自主通气 通气（SpV）仍然是护理的重大挑战。是 据估计，9-37%的机械通气患者难以 由于血流动力学不稳定引起的从MV到SpV的立即过渡 左心室功能障碍本研究的目的是 检查干预措施以优化心肺（CP）血流动力学变化 与从MV到SpV的立即过渡相关，同时比较 常用模式（T形管、持续气道正压通气和压力 支持）在有和无心脏的犬受试者中的自主通气 失败具体的目的是：1）比较预负荷的影响， 呋塞米利尿前后血容量正常和高血容量 在从MV到SpV的过渡期间对CP血流动力学的影响（T形件，CPAP和PS）， 正常犬（GI）和心力衰竭（起搏）犬（GII）。2)比较 硝普钠降低后负荷前后CP血流动力学变化 在GI和GII中从MV过渡到SpV（T形管、CPAP和PS）期间 犬齿3)以确定CP血流动力学变化是否与 在利尿或后负荷之前和之后从MV过渡到SpV 减少改变自主神经系统的张力，反映了心率 GI和GII犬的变异性。样本将由116只犬科动物组成 随机分配至GI或GII。GII犬将接受起搏器 插入并起搏7周以产生心动过速慢性充血性 心衰在麻醉状态下，受试者将被仪器化， 现有技术的生物技术包括右心室射血分数肺 动脉导管和Millar微压计压力导管测量右 心室功能、电导导管和米勒微压计 压力导管连续测量左心室功能。数据 将使用重复测量多变量方差分析进行分析。的 这项研究的结果将提供深入了解优化的方法， 心血管功能和选择适当的自发模式 基于心血管状态的通气，可以在以后的 人体随机对照试验。