negative- versus positive-pressure ventilation in intubated patients with acute respiratory distress syndrome消极的u2014u2014与正压通风插管患者急性呼吸窘迫综合征.pdfVIP

Raymondos et al. Critical Care 2012, 16:R37 /content/16/2/R37 RESEARCH Open Access Negative- versus positive-pressure ventilation in intubated patients with acute respiratory distress syndrome 1* 1 1 1 1 1 Konstantinos Raymondos , Ulrich Molitoris , Marcus Capewell , Björn Sander , Thorben Dieck , Jörg Ahrens , Christian Weilbach2, Wolfgang Knitsch3 and Antonio Corrado4 Abstract Introduction: Recent experimental data suggest that continuous external negative-pressure ventilation (CENPV) results in better oxygenation and less lung injury than continuous positive-pressure ventilation (CPPV). The effects of CENPV on patients with acute respiratory distress syndrome (ARDS) remain unknown. Methods: We compared 2 h CENPV in a tankrespirator (iron lung”) with 2 h CPPV. The six intubated patients developed ARDS after pulmonary thrombectomy (n = 1), aspiration (n = 3), sepsis (n = 1) or both (n = 1). We used a tidal volume of 6 ml/kg predicted body weight and matched lung volumes at end expiration. Haemodynamics were assessed using the pulse contour cardiac output (PiCCO) system, and pressure measurements were referenced to atmospheric pressure. Results: CENPV resulted in better oxygenation compared to CPPV (median ratio of arterial oxygen pressure to fraction of inspired oxygen of 345 mmHg (minimum-maximum 183 to 438 mmHg) vs 256 mmHg (minimum- maximum 123 to 419 mmHg) (P 0.05). Tank pressures were -32.5 cmH2O (minimum-maximum -30 to -43) at end inspiration and -15 cmH O (minimum-maximum -15 to -19 cmH O) at end expiration. NO Inspiratory 2 2 transpulmonary pressures decreased (P = 0.04) and airway pressures we