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首页> 外文期刊>Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies >Helium-oxygen therapy for pediatric acute severe asthma requiring mechanical ventilation.
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Helium-oxygen therapy for pediatric acute severe asthma requiring mechanical ventilation.

机译：需要机械通气的小儿急性重症哮喘的氦氧治疗。

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OBJECTIVE: To illustrate the use of helium-oxygen gas mixtures as therapy for pediatric patients with acute severe asthma requiring conventional mechanical ventilation. DESIGN: Retrospective review. SETTING: Tertiary care children's teaching hospital. PATIENTS: All mechanically ventilated patients with severe asthma admitted to the pediatric intensive care unit from August 1994 to October 2000. INTERVENTIONS: Within 24 hrs of intubation or admission, patients were stabilized on volume ventilation, bronchodilator therapy, corticosteroids, and antibiotics when indicated. Hypercapnia was permitted while maintaining arterial blood gas pH > or =7.25. A helium-oxygen gas mixture then was begun with helium flow set at 5-7 L/min, and oxygen flow was titrated to maintain desired oxygen saturation. Only sedated, chemically paralyzed patients with adequate pre-helium-oxygen and post-helium-oxygen measurements were statistically analyzed. MEASUREMENTS AND MAIN RESULTS: Twenty-eight mechanically ventilated patientswith severe asthma placed on helium-oxygen gas mixtures were identified who met study entry criteria. Mean patient age was 8.8 yrs (range, 1.1-14.6). Before helium-oxygen therapy began, mean peak inspiratory pressure was 40.5 +/- 4.2 cm H(2)O, mean arterial blood gas pH was 7.26 +/- 0.05, and mean CO(2) partial pressure was 58.2 +/- 8.5 torr. After patients were placed on helium-oxygen therapy, there was a significant decrease in mean peak inspiratory pressure to 35.3 +/- 3.0 cm H(2)O. Mean pH increased significantly to 7.32 +/- 0.06, and mean partial pressure CO(2) decreased significantly to 50.5 +/- 7.4 torr. Initial mean inspired helium was 57 +/- 4% (range, 32-74). Mechanical ventilation days ranged from 1 to 23 days (mean, 5.0). Hospital stay ranged from 4 to 29 days (mean, 10.1), with an average pediatric intensive care unit stay of 6.9 days (range, 2-24). There were two incidences of pneumothorax. CONCLUSIONS: In the pediatric patient with severe asthma requiring conventional mechanical ventilation, helium-oxygen administration appears to be a safe therapy and may assist in lowering peak inspiratory pressure and improving blood gas pH and partial pressure CO(2).
机译：目的：说明使用氦氧混合气作为需要常规机械通气的急性重症哮喘小儿患者的治疗方法。设计：回顾性审查。地点：三级护理儿童教学医院。患者：1994年8月至2000年10月，所有重度哮喘的机械通气患者均进入儿科重症监护病房。干预措施：在插管或入院24小时内，患者在通气，支气管扩张药，皮质类固醇和抗生素治疗时均保持稳定。高碳酸血症被允许，同时维持动脉血气的pH值≥7.25。然后开始氦气气体混合物，氦气流量设置为5-7 L / min，并滴定氧气流量以保持所需的氧气饱和度。仅对镇静的化学麻痹的患者进行足够的氦前氧和氦后氧测量，以进行统计学分析。测量和主要结果：确定了28例患有严重哮喘的机械通气患者，他们接受了氦氧混合气，符合研究入组标准。平均患者年龄为8.8岁（范围1.1-14.6）。在开始氦氧治疗之前，平均吸气峰值为40.5 +/- 4.2 cm H（2）O，平均动脉血气pH为7.26 +/- 0.05，平均CO（2）分压为58.2 +/- 8.5托尔患者接受氦氧治疗后，平均峰值吸气压力明显降低至35.3 +/- 3.0 cm H（2）O。平均pH值显着增加至7.32 +/- 0.06，平均分压CO（2）显着降低至50.5 +/- 7.4托。最初的平均吸入氦气为57 +/- 4％（范围32-74）。机械通气天数为1到23天（平均5.0）。住院时间为4到29天（平均10.1），小儿重症监护病房的平均住院时间为6.9天（范围2-24）。气胸有两次发生。结论：在需要常规机械通气的严重哮喘儿科患者中，给予氦氧似乎是一种安全的治疗方法，可能有助于降低峰值吸气压力并改善血气pH和分压CO（2）。

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