IS TRACHEAL GAS INSUFFLATION AN ALTERNATIVE TO EXTRAPULMONARY GAS EXCHANGERS IN SEVERE ARDS

被引：25

作者：

BELGHITH, M ^{[1
]}

FIEROBE, L ^{[1
]}

BRUNET, F ^{[1
]}

MONCHI, M ^{[1
]}

MIRA, JP ^{[1
]}

机构：

[1] COCHIN UNIV HOSP,DEPT PHYSIOL,PARIS,FRANCE

来源：

CHEST | 1995年 / 107卷 / 05期

关键词：

ADULT RESPIRATORY DISTRESS SYNDROME; AIRWAY INSUFFLATION; INTRATRACHEAL INSUFFLATION; PULMONARY BAROTRAUMA; TRACHEAL GAS INSUFFLATION;

D O I：

10.1378/chest.107.5.1416

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Tracheal gas insufflation (TGI) of pure oxygen combined with mechanical ventilation decreases dead space and increases COB clearance. In the present study, TGI was used in six patients with ARDS who met extracorporeal membrane oxygenation criteria and who were severely hypoxemic and hypercapnic despite optimal pressure-controlled ventilation. This open clinical study aimed to investigate the effects of 4 L/min continuous now of oxygen given via an intratracheal catheter. PaCO2 decreased from 108+/-32 to 84+/-26 mm Hg (p<0.05), and no significant change in PaO2 (68+/-18 vs 96+/-43, p=0.06). There was no change in airway pressures and hemodynamic variables, A slight increase in end-expiratory and end-inspiratory volumes with TGI possibly occurred, as seen on tracings from respiratory inductive plethysmography (Respitrace). We conclude that TGI improves tolerance of limited pressure ventilation by removing CO2, but it may induce changes in lung volumes that are not detected by ventilator measurements.

引用

页码：1416 / 1419

页数：4

共 25 条

[1] Pingleton SK, Complications of acute respiratory failure, Am Rev Respir Dis, 137, pp. 1463-1493, (1988)
[2] Tsuno K, Miura K, Takeya M, Et al., Histopathologic pulmonary changes from mechanical ventilation at high peak airway pressures, Am Rev Respir Dis, 143, pp. 1115-1120, (1991)
[3] Dreyfuss D, Soler P, Basset G, Et al., High inflation pressure pulmonary edema, Am Rev Respir Dis, 137, pp. 1159-1164, (1988)
[4] Gattinoni L, Pesenti A, Mascheroni D, Et al., Low-frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure, JAMA, 256, pp. 881-886, (1986)
[5] Brunet F, Belghith M, Mira JP, Et al., ECC02R-LFPPV improves arterial oxygenation while reducing risk of pulmonary barotrauma in patients with ARDS, Chest, 104, pp. 889-898, (1993)
[6] Mortensen JD, An intravenacaval blood gas exchange device: a preliminary report, Trans Am Soc Artif Intern Organs, 33, pp. 570-573, (1987)
[7] Hickling KG, Henderson SJ, Jackson R., Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome, Intensive Care Med, 16, pp. 372-377, (1990)
[8] Pesenti A., Target blood gases during ARDS ventilatory management, Intensive Care Med, 16, pp. 349-351, (1990)
[9] Ravenscraft SA, Burke WC, Nahum A, Et al., Tracheal gas insufflation augments CO2 clearance during mechanical ventilation, Am Rev Respir Dis, 148, pp. 345-351, (1993)
[10] Burke WC, Nahum A, Ravenscraft SA, Et al., Modes of tracheal gas insufflation: comparison of continuous and phase-specific gas injection in normal dogs, Am Rev Respir Dis, 148, pp. 562-568, (1993)

← 1 2 3 →