创伤合并ARDS患者适应性支持通气加肺复张策略的疗效分析

目的 探讨适应性支持通气(adaptive support ventilation，ASV)模式加肺复张策略(lung recruitment maneuvers，LRM)与间歇正压通气(intermittent positive pressure ventilation，IPPV)模式对创伤合并ARDS患者的疗效。 ...

Curative effect of adaptive support ventilation plus lung recruitment maneuvers for trauma patients combined with ARDS

Objective To investigate the effect of adaptive support ventilation (ASV) plus lung recruitment maneuvers (LRM) and intermittent positive pressure ventilation (IPPV) on respiratory mechanics, hemodynamics and oxygen delivery in trauma patients combined with acute respiratory distress syndrome (ARDS). Methods Twenty-eight trauma patients combined with ARDS including 18 males and 10 females at age range of 19-48 years were mechanically ventilated by two modes, ie, IPPV and ASV + LPS.The patient was initially ventilated with IPPV for eight hours, with tidal volume (VT) of 10 ml/kg, PEEP = 0, oxygen delivery speed for 32 L/min and oxygen inhalation concentration of 60％.Then, one of ASV + LRM and IPPV was randomly selected for continual ventilation.There were three levels of positive end-expiratory pressure (PEEP,0,5 and 10 cmH2O).Each level of PEEP was maintained for 60 minutes.During the use of ASV + LRM, continuous positive airway pressure (CPAP) was at 45cmH2O and breath holding continued for 30 seconds.Then, the mode was turned to ASV and respiratory mechanics, hemodynamics and oxygen delivery were measured by using Swan-Ganz catheter, electrocardioscanner and ventilator when each level of PEEP was ventilated for 50 minutes. Results Compared with IPPV mode in the same level of PEEP, ASV + LRM mode had lower peak inflating pressure (PIP),airway plate pressure (Pplat) and intrapulmonary shunt (Qs/Qt) (P ＜ 0.05) but higher oxygenation index (PaO2/FiO2) and oxygen delivery (DO2) (P ＜ 0.05).There was no statistical difference in aspects of MAP, CI and SVRI during ventilation with IPPV and ASV (P ＞ 0.05). Conclusion ASV + LPS model is better than IPPV in ventilation for trauma patients combined with ARDS.