|
|
|
|
|
Study on avoiding spurious triggering of ventilator during mechanical chess compression |
Huang Xing-wei, Su Ya-yan, Chen Mao-guang |
Fujian Medical University Affiliated Mindong Hospital, Ningde 355000, China |
|
|
Abstract Objective To use cardiopulmonary resuscitation machine for chest external pressure, such as mechanical ventilation (MV) according to normal parameters, easily trigger the ventilator to cause excessive ventilation and cause adverse consequences. The purpose of this experiment is to study how to avoid the spurious triggering of the ventilator in the process of using the cardiopulmonary resuscitation machine. Methods Eighty-three patients with respiratory cardiac arrest were randomly divided into two groups. V-SIMV plus 0 PSV and V-A/C plus -20 cm H2O pressure trigger sensitivity were used for ventilation respectively. The initial setting of ventilator high pressure alarm was 60 cm H2O. Then adjust according to the Peak airway pressure. Due to the significant differences in the time of onset, starting pressing time, and basic diseases between different patients, the comparison of physiological and biochemical indicators, oxygenation indicators, ROSC, and survival rates between the two groups was not statistically significant and did not include statistics. Due to the urgency of rescue, no esophageal pressure was measured. Results There was no spurious triggering between the two groups, and there was no difference in the incidence of high pressure alarm and the level of peak airway pressure between the two groups [2.3% vs.2.5%,(46.74±4.12)cm H2O vs.(47.33±3.48)cm H2O, P>0.05]. The ratio of minute ventilation volume to ideal body weight (MV/kg) was higher than expected in the two groups, and there was a significant difference in the MV/kg comparison between the two groups[(152.55±6.25)mL/(kg·min) vs.(70.98±1.07)mL/(kg·min),P<0.01]. However, the MV shown on the ventilator when the chest is pressed is not a response to the patient′s real situation. Conclusion When using cardiopulmonary resuscitation machine with CPR, selecting V-SIMV plus 0 PSV or selecting V-A/C plus maximum negative pressure trigger sensitivity can avoid the ventilator being spurious triggered. Raising the upper limit of the pressure alarm and adjusting it according to the patient′s peak airway pressure can reduce the incidence of high pressure alarm.
|
|
About author:: Huang Xing-wei, E-mail: 423835286@qq.com |
|
|
|
[1]Bhanji F, Donohue AJ, Wolff MS, et al. Part 14: Education: 2015 American Heart Association Guidelines Up-date for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J]. Circulation, 2015, 132(18 suppl 2): 561-573.
[2]李培军,李军山,杨东艳,等.用理想体重设置心脏术后机械通气初始参数的研究[J].中国循环杂志, 2005, 20(5): 378-380.
[3]Tan D, Xu J, Shao S,et al. Comparison of different inspiratory triggering settings in automated ventilators during cardiopulmonary resuscitation in a porcine model[J]. PLoS One, 12(2): e0 171 869.
[4]王娇.心肺复苏新进展[J].中国急救医学, 2014, 34(3): 262-265.
[5]Steen S, Liao Q, Pierre L, et al. Continuous intratracheal insufflation of oxygen improves the efficacy of mechanical chest compression- active decompression CPR[J]. Resuscitation, 2004, 62 (2): 219-227.
[6]Cordioli RL, Lyazidi A, Rey N, et al. Impact of ventilation strategies during chest compression. An experimental study with clinical observations[J]. J Appl Physiol (1985), 2016, 120(2): 196-203.
[7]Berg RA, Kern KB, Hilwig RW, et al. Assisted ventilation during ′bystander′ CPR in a swine acute myocardial infarction model doesnot improve outcome[J]. Circulation, 1997, 96(12): 4364-4371.
[8]沈洪,黄子通.心肺脑复苏[M]//沈洪,刘中民.急诊与灾难医学.第2版.北京:人民卫生出版社, 2013:235-251.
[9]刘勇,黄亮, 杨继斌,等. 不同潮气量机械通气对复苏犬支气管灌洗液中 Toll样受体 4 变化的影响[J]. 中国急救医学, 2012, 32(8): 704-708.
[10]邵诗幻,于学忠.心脑复苏的研究进展[J].中国急救医学, 2017, 37(6): 572-575.
[11]楼滨城,朱继红.2015美国心脏协会(AHA)心肺复苏与心血管急救更新指南解读之二 高级心肺复苏[J].临床误诊误治, 2016, 29(2): 71-74.
[12]冯庚.高质量基础心肺复苏的5个要素[J].中华卫生应急电子杂志, 2017, 3(4): 209-211.
[13]Bobrow BJ, Ewy GA, Clark L, et al. Passive oxygen insufflationis superior to bag-valve-mask ventilation for witnessedvenTriggercular fibrillation out - of-hospital cardiacarrest[J]. Ann Emerg Med, 2009, 54(5): 656 -662.
[14]郑杨,赵巍.2015年AHA心肺复苏及心血管急救指南更新解读[J].中国实用内科杂志, 2016, 36(4): 292-294.
[15]Kleinman ME, Goldberger ZD, Rea T, et al. 2017 American Heart Association focused update on adult basic life support and cardiopulmonary resuscitation quality: an update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J]. Circulation, 2018, 137(1): e7-e13.[16]朱蕾. 机械通气(第3版)[M]. 上海:上海科技出版社, 2012:66-68.
[17]张纳新,秦英智.机械通气[M]//姚咏明.急危重症病理生理学.北京:科学出版社, 2013:721-748.
[18]中国研究型医院学会心肺复苏学专业委员会.2016中国心肺复苏专家共识[J].中华灾害救援医学, 2017, 5(1): 1-23.
[19]金肖,高丽娟,陈晓,等.心脑血管疾病患者心肺复苏期间不同呼吸机参数设置对经皮氧饱和度的影响[J].中国现代医生, 2016, 54(16): 147-149.
[20]欧阳后华,梁大胜,蓝海霞,等.不同辅助通气方法对心肺复苏的影响[J].医学综述, 2015, 21(17): 3264-3265.
[21]金肖,高丽娟,韦铁民,等.合并有心脑血管病患者心肺复苏时机械通气中气道高压报警上限的设置分析[J].中国现代医生, 2016, 54(17): 21-24.
[22]Chalkias A, Pavlopoulos F, Koutsovasilis A, et al. Airway pressure and outcome of out-of-hospital cardiac arrest: A prospective observational study[J]. Resuscitation, 2017, 110:101-106. |
|
|
|