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首页> 外文期刊>Current therapeutic research, clinical and experimental. >Efficacy of Lung Recruitment Maneuver with High-Level Positive End-Expiratory Pressure in Patients with Influenza-Associated Acute Respiratory Distress: A Single-Center Prospective Study
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Efficacy of Lung Recruitment Maneuver with High-Level Positive End-Expiratory Pressure in Patients with Influenza-Associated Acute Respiratory Distress: A Single-Center Prospective Study

机译：高水平呼气末正压通气治疗与流感相关的急性呼吸窘迫患者的疗效：单中心前瞻性研究

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Background: The latest data released to the public from the Chinese Ministry of Health reported 120,940 confirmed H1N1 cases and 659 deaths on the Chinese mainland.Objective: We performed a prospective, single-center study to investigate the efficacy of lung recruitment maneuver (RM) with high-level positive end-expiratory pressure (PEEP) in patients with the 2009 influenza A (HlNl)-associated acute respiratory distress syndrome (ARDS).Methods: Eighty-four patients with H1N1-associated ARDS were admitted to emergency intensive care units between October 2009 and February 2012. During pressure control ventilation, if arterial oxygen saturation (SpO2) is consistently < 88% for > 30 minutes, an RM with high-level PEEP is performed to normalize lung volume at 30 cmH20 for 60 seconds. The RM was considered initially a responder if SpO2 increased > 3% within 15 minutes; otherwise, an SpO2 increase < 3% would be considered initially a nonresponder. Variations on oxygen metabolism and hemodynamic parameters were also measured before and after initial RM with high-level PEEP.Results: After the initial RM, 40 patients (47.6%) with influenza-associated ARDS displayed an increase ( > 3%) in SpO2 (the responder group), and 44 patients (52.4%) had no significant improvement ( < 3%) in SpO2 (the nonresponder group). Among 84 patients with influenza-associated ARDS, 56 patients survived and 28 patients died. There was significant difference in mortality rate between the responder group and the nonresponder group (7 out of 40 vs 18 out of 44; P = 0.019). The initial PEEP level in the responder group was lower than that of the nonresponder group (P -0.028). The initial mean duration of mechanical ventilation in the responder group was also shorter than that of the nonresponder group (P = 0.011). Furthermore, the initial dynamic lung-thorax compliance was obviously higher in the initially responder group than in the nonresponder group [P = 0.038).Conclusions: Initial response of lung RM with high-level PEEP may be associated with good clinical outcome of patients with influenza-associated ARDS. The initial PEEP level, duration of mechanical ventilation, and dynamic lung-thorax compliance dynamic lung-thorax compliance may be potential factors in influencing the initial response to RM.
机译：背景：中国卫生部向公众发布的最新数据报告，中国大陆确诊的H1N1病例为120,940例，死亡659例。目的：我们进行了一项前瞻性，单中心研究，研究了肺募集策略（RM）的有效性2009年甲型H1N1相关急性呼吸窘迫综合征（ARDS）患者的高呼气末正压（PEEP）水平。方法：将84例H1N1相关ARDS患者入院重症监护室在2009年10月至2012年2月之间。在压力控制通气期间，如果动脉血氧饱和度（SpO2）在30分钟内始终<88％，则使用高PEEP的RM来使30 cmH20的肺容量正常化60秒。如果SpO2在15分钟内增加> 3％，则最初将RM视为响应者。否则，最初将SpO2增加<3％视为无反应。在高浓度PEEP初始RM之前和之后，还测量了氧代谢和血液动力学参数的变化。结果：初始RM后，与流感相关的ARDS的40例患者（47.6％）的SpO2升高（> 3％）（无反应者组），其中44例（52.4％）患者的SpO2没有明显改善（<3％）。在84例与流感相关的ARDS患者中，有56例存活，28例死亡。有反应者组与无反应者组之间的死亡率有显着差异（40人中有7人，44人中有18人; P = 0.019）。应答者组的初始PEEP水平低于无应答者组（P -0.028）。响应者组的机械通气初始平均持续时间也短于无响应者组（P = 0.011）。此外，初始反应者组的初始动态肺胸顺应性明显高于无反应者组[P = 0.038]。结论：高水平PEEP对肺RM的初始反应可能与高反应性肺病患者的临床预后有关。流感相关的ARDS。最初的PEEP水平，机械通气时间和动态的肺-胸腔顺应性可能是影响RM初始反应的潜在因素。

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