AUTO-PEEP IN THE MULTISYSTEM INJURED PATIENT - AN ELUSIVE COMPLICATION

被引:13
作者
MOORE, FA
HAENEL, JB
MOORE, EE
ABERNATHY, CM
机构
[1] Department of Surgery, Denver General Hospital and the University of Colorado Health Science Center, Denver
关键词
D O I
10.1097/00005373-199011000-00002
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Auto-PEEP (A-PEEP), unrecognized alveolar positive end expiratory pressure during mechanical ventilation, is an acknowledged hazard in patients with chronic obstructive lung disease. We evaluated 50 consecutive trauma patients for the presence of A-PEEP and its effect on hemodynamic stability. Injury Severity Scores (ISS) were 8 to 41 (21 ± 1); Revised Trauma Scores (RTS) ranged from 2.0 to 7.8 (6.2 ± 0.2). Mode of ventilation was assist control, inspiratory flow rates were 40 to 120 L/M (78 ± 2). A-PEEP, determined in the non-assisting patient by occluding the expiratory port at end exhalation, was present in 28 patients (56%) and ranged from 1 to 12 cm H20 (5.3 ± 0.4 cm H20). Data segregated by A-PEEP versus no A-PEEP were as follows (Mean ± SEM): A-PEEP: No A-PEEP (N = 28) (AT =22) Variable VE (L/M) 19.1 ±1.1 15.1 ±0.6* ISS 22.9 ± 1.7 18.1 ± 1.3* RTS 5.8 ± 0.4 6.7 ± 0.2* Paw (cm H2O) 12.5 ± 0.6 7.4 ± 0.5* Pulmonary contusion 7 (25%) 1 (5%)* * P < 0.05, VE = minute ventilation, Paw = mean airway pressure. Upon reversal of A-PEEP in the eight patients with levels >5 cm H2O, mean blood pressure rose from 90 ± 17 to 102 ± 22 mm Hg and central venous pressure fell from 13±5to7±5 mm Hg. A-PEEP was successfully treated in these eight patients by increasing peak flows, minimizing VE requirements and selective use of bronchodilators. In sum, the hypermetabolic ventilated trauma patient should be monitored routinely for this common phenomenon which may have profound cardiopulmonary effects in the setting of acute resuscitation. © 1990 by The Williams and Wilkins Co.
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页码:1316 / 1323
页数:8
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