Intercomparison of recruitment maneuver efficacy in three models of acute lung injury
Intercomparison of recruitment maneuver efficacy in three models of acute lung injury
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DOI：
10.1097/01.ccm.0000147445.73344.3a
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发表时间：
2004-12-01
影响因子：
8.8
通讯作者：
Marini, JJ
中科院分区：
文献类型：
--
作者：
Lim, SC;Adams, AB;Marini, JJ
目的：比较三种复吸手法在不同病理解剖特征的急性肺损伤模型中的相对疗效。设计：我们在三种不同的猪急性肺损伤模型中比较了三种招募机动（RM）技术在三个水平的RM后呼气末正压：油酸损伤；单纯由气道高压机械应力引起的损伤；肺炎球菌肺炎。临床研究机构的实验室。28头麻醉的杂交猪（23.8±2.6 kg）。测试的RM技术包括持续充气，延长呼气或呼气末正压增加，以及压力控制通气。主要测量：氧合和呼气末肺容量。主要结果：RM后呼气末正压水平是操作后Pao的主要决定因素(2)，独立于RM技术。在呼吸机诱导的肺损伤模型中，压力控制通气RM引起Pao(2)的持续增加，但在油酸损伤和肺炎球菌肺炎中，任何RM技术（持续充气、增量呼气末正压或压力控制通气）与没有RM的呼气末正压升高没有持续的氧合差异。结论：尽管压力控制通气的平均气道压力较低，血流动力学损害的风险降低，但在所有测试的急性肺损伤模型中，压力控制通气的招募相当于或优于持续充气，其峰值压力相同。虽然在某些损伤情况下使用传统的潮气量时，RM可以改善Pao(2)，但持续的改善取决于RM后的呼气末正压值。
Objective: To compare the relative efficacy of three forms of recruitment maneuvers in diverse models of acute lung injury characterized by differing pathoanatomy.Design: We compared three recruiting maneuver (RM) techniques at three levels of post-RM positive end-expiratory pressure in three distinct porcine models of acute lung injury: oleic acid injury; injury induced purely by the mechanical stress of high-tidal airway pressures; and pneumococcal pneumonia.Setting. Laboratory in a clinical research facility.Subjects. Twenty-eight anesthetized mixed-breed pigs (23.8 +/- 2.6 kg).Interventions. The RM techniques tested were sustained inflation, extended sigh or incremental positive end-expiratory pressure, and pressure-controlled ventilation.Primary Measurements: Oxygenation and end-expiratory lung volume.Main Results: The post-RM positive end-expiratory pressure level was the major determinant of post-maneuver Pao(2), independent of the RM technique. The pressure-controlled ventilation RM caused a lasting increase of Pao(2) in the ventilator-induced lung injury model, but in oleic acid injury and pneumococcal pneumonia, there were no sustained oxygenation differences for any RM technique (sustained inflation, incremental positive end-expiratory pressure, or pressure-controlled ventilation) that differed from raising positive end-expiratory pressure without RM.Conclusions: Recruitment by pressure-controlled ventilation is equivalent or superior to sustained inflation, with the same peak pressure in all tested models of acute lung injury, despite its lower mean airway pressure and reduced risk for hemodynamic compromise. Although RM may improve Pao(2) in certain injury settings when traditional tidal volumes are used, sustained improvement depends on the post-RM positive end-expiratory pressure value.