Application of Adaptive Support Ventilation Plus Lung Recruitment Maneuvers in Patients with Traumatic Brain Injuries Complicated with ARDS_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 HanQiu , LiJing , PengYigen , DuYeping

Intensive Care Unit, Huai'an Second People's Hospital Affiliated to Xuzhou Medical College, Huai'an, Anhui, 223002, China;

Corresponding?author：

HanQiu, Email: 108704880@qq.com

Keywords：

Acute respiratory distress syndrome; Trauatic brain injuries; Adaptive support ventilation; Lung recruitment maneuvers

DOI：

10.7507/1671-6205.2014062

Video：

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Objective To investigate the value of adaptive support ventilation (ASV) plus lung recruitment maneuvers (LRM) for patients with traumatic brain injuries combined with ARDS. Methods Thirty trauatic brain injuried patients combined with ARDS including 18 males and 12 females at age of 15-76 years were mechanically ventilated by SIMV+PSV or ASV+LRM.The patient was initially ventilated with SIMV for 8 hours,with tidal volume(VT)of 8 mL/kg,PEEP=0,oxygen inhalation concentration of 60%.Then,one of ASV+LRM and SIMV modes was randomly selected for continual ventilation.The positive end-expiratory pressure were set at three levels (PEEP 0,5 and 10 cm H₂O).Each level of PEEP was maintained for 60 minutes.During the use of ASV+LRM,pressure controlled ventilation (PCV) was at 40 cm H₂O and breath holding continued for 30 seconds.Then,the mode was turned to ASV.Respiratory mechanics,hemodynamics,blood gas,oxygen delivery,intracranial pressure and other indicators were measured when each level of PEEP was ventilated for 50 minutes. Results Compared with SIMV mode in the same level of PEEP,ASV+LRM mode had lower peak inflating pressure (PIP),airway plate pressure(Pplat) and intrapulmonary shunt(Qs/Qt),central venous pressure(CVP),intracranial pressure(ICP),but higher oxygenation index (PaO₂/FiO₂) and partial pressure of oxygen (PaO₂)(all P<0.05).There was no statistical difference in MAP between two modes (P>0.05). Conclusion ASV+LRM mode is better than SIMV in ventilation for traumatic brain injuried patients combined with ARDS.

Citation： HanQiu, LiJing, PengYigen, DuYeping. Application of Adaptive Support Ventilation Plus Lung Recruitment Maneuvers in Patients with Traumatic Brain Injuries Complicated with ARDS. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(3): 259-262. doi: 10.7507/1671-6205.2014062 Copy

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8.	張納新,王平,秦英智.11249例機械通氣患者脫機失敗原因分析.中國危重病急救醫學,2001,12:116-117.
9.	邱海波,陳德昌.呼吸機脫機的指征手段及其評價.中國危重病急救醫學,1996,8:377-380.

1. 中華醫學會重癥醫學分會.急性肺損傷/急性呼吸窘迫綜合征診斷和治療指南.中華急診醫學雜志,2007,16:343-349.
2. Laubscher TP,Frutiger A,Fanconi S,et al.The automatic selection of ventilation parameters during the initial phase of mechanical ventilation.Intensive Care Med,1996,22:199-207.
3. Linton DM,Potgieter PD,Davis S,et al.Automatic weaning from mechanical ventilation using an adaptive lung ventilation controller.Chest,1994,106:1843-1850.
4. Demaika TA,Keddissi JI,Kinasewitz GT.Update on ARDS:beyond the low tidal volume.Am J Met Sei,2009,337:360-363.
5. Brower RC,Rubenfeld GD.Lung-protective ventilation strategies in acute lung injury.Crit Care Med,2003,31:312-316.
6. Jia X,Malhotra A,Saeed M,et al.Risk factors for ARDS in patients receiving mechanical ventilation for>48 h.Chest,2008,133:853-861.
7. Yang KL,TobinMJ.A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilationl.Engl J Med,1991,324:1445-1450.
8. 張納新,王平,秦英智.11249例機械通氣患者脫機失敗原因分析.中國危重病急救醫學,2001,12:116-117.
9. 邱海波,陳德昌.呼吸機脫機的指征手段及其評價.中國危重病急救醫學,1996,8:377-380.

Chinese Journal of Respiratory and Critical Care Medicine

Application of Adaptive Support Ventilation Plus Lung Recruitment Maneuvers in Patients with Traumatic Brain Injuries Complicated with ARDS

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