当前位置: X-MOL 学术ICMx › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Management of primary blast lung injury: a comparison of airway pressure release versus low tidal volume ventilation
Intensive Care Medicine Experimental Pub Date : 2020-06-23 , DOI: 10.1186/s40635-020-00314-2
Timothy E Scott 1 , Anup Das 2 , Mainul Haque 3 , Declan G Bates 2 , Jonathan G Hardman 4, 5
Affiliation  

Background Primary blast lung injury (PBLI) presents as a syndrome of respiratory distress and haemoptysis resulting from explosive shock wave exposure and is a frequent cause of mortality and morbidity in both military conflicts and terrorist attacks. The optimal mode of mechanical ventilation for managing PBLI is not currently known, and clinical trials in humans are impossible due to the sporadic and violent nature of the disease. Methods A high-fidelity multi-organ computational simulator of PBLI pathophysiology was configured to replicate data from 14 PBLI casualties from the conflict in Afghanistan. Adaptive and responsive ventilatory protocols implementing low tidal volume (LTV) ventilation and airway pressure release ventilation (APRV) were applied to each simulated patient for 24 h, allowing direct quantitative comparison of their effects on gas exchange, ventilatory parameters, haemodynamics, extravascular lung water and indices of ventilator-induced lung injury. Results The simulated patients responded well to both ventilation strategies. Post 24-h investigation period, the APRV arm had similar PF ratios (137 mmHg vs 157 mmHg), lower sub-injury threshold levels of mechanical power (11.9 J/min vs 20.7 J/min) and lower levels of extravascular lung water (501 ml vs 600 ml) compared to conventional LTV. Driving pressure was higher in the APRV group (11.9 cmH 2 O vs 8.6 cmH 2 O), but still significantly less than levels associated with increased mortality. Conclusions Appropriate use of APRV may offer casualties with PBLI important mortality-related benefits and should be considered for management of this challenging patient group.

中文翻译:

原发性爆炸性肺损伤的处理:气道压力释放与低潮气量通气的比较

背景 原发性爆炸性肺损伤 (PBLI) 表现为暴露于爆炸性冲击波引起的呼吸窘迫和咯血综合征,是军事冲突和恐怖袭击中常见的死亡和发病原因。目前尚不清楚管理 PBLI 的最佳机械通气模式,并且由于该疾病的散发性和暴力性,不可能在人体中进行临床试验。方法 PBLI 病理生理学的高保真多器官计算模拟器被配置为复制来自阿富汗冲突的 14 名 PBLI 伤亡人员的数据。实施低潮气量 (LTV) 通气和气道压力释放通气 (APRV) 的适应性和响应性通气方案适用于每个模拟患者 24 小时,允许直接定量比较它们对气体交换、通气参数、血液动力学、血管外肺水和呼吸机引起的肺损伤指数的影响。结果模拟患者对两种通气策略反应良好。在 24 小时调查期后,APRV 组具有相似的 PF 比(137 mmHg 与 157 mmHg)、较低的机械动力亚损伤阈值水平(11.9 J/min 与 20.7 J/min)和较低水平的血管外肺水( 501 毫升 vs 600 毫升)与传统 LTV 相比。APRV 组的驾驶压力较高(11.9 cmH 2 O 对 8.6 cmH 2 O),但仍显着低于与死亡率增加相关的水平。
更新日期:2020-06-23
down
wechat
bug