Effect of extra corporeal reducing pre-load on pulmonary mechanical power in patients with acute respiratory distress syndrome.
10.3760/cma.j.cn121430-20240117-00054
- Author:
Wenwen ZHANG
1
;
Xin'gang HU
2
,
3
;
Lixia YUE
1
;
Jie ZHANG
2
,
3
;
Zhida LIU
2
,
3
;
Shuai GAO
2
,
3
;
Zhigang ZHAO
2
,
3
;
Xinliang LIANG
1
Author Information
1. Department of Public Utilities Development, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, Henan, China.
2. Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 450003, Henan, China. Corresponding author: Liang Xinliang, Email: lxlshy-120@
3. com.
- Publication Type:Journal Article
- MeSH:
Humans;
Respiratory Distress Syndrome/physiopathology*;
Retrospective Studies;
Carbon Dioxide;
Blood Gas Analysis;
Lung/physiopathology*;
Intensive Care Units;
Male;
Female;
Noninvasive Ventilation/methods*;
Continuous Renal Replacement Therapy/methods*;
APACHE;
Middle Aged
- From:
Chinese Critical Care Medicine
2024;36(12):1244-1248
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To explore the effects of veno-venous extra corporeal carbon dioxide removal (V-V ECCO2R) on local mechanical power and gas distribution in the lungs of patients with mild to moderate acute respiratory distress syndrome (ARDS) receiving non-invasive ventilation.
METHODS:Retrospective research methods were conducted. Sixty patients with mild to moderate ARDS complicated with renal insufficiency who were transferred to the respiratory intensive care unit (RICU) through the 96195 platform critical care transport green channel from January 2018 to January 2020 at the collaborative hospitals of Henan Provincial People's Hospital were enrolled. According to different treatment methods, they were divided into a conventional treatment group and an ECCO2R group, with 30 patients in each group. Both groups received standard treatments including primary disease treatment, airway management, and non-invasive ventilation. The conventional treatment group received bedside continuous renal replacement therapy (CRRT), and the ECCO2R group received V-V ECCO2R treatment. General information of patient such as gender, age, cause of disease, and acute physiology and chronic health evaluation II (APACHE II) were recorded; arterial blood gas analysis was performed before treatment and at 12 hours and 24 hours during treatment, recording arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and oxygenation index (PaO2/FiO2). Respiratory mechanics parameters [tidal volume, respiratory rate, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP)] were recorded, and the rapid shallow breathing index (RSBI) was calculated; electrical impedance tomography (EIT) was used to measure regional of interest (ROI) values in different lung areas at 12 hours and 24 hours of treatment, and the pulmonary mechanical energy was calculated.
RESULTS:The arterial blood gas analysis indicators, respiratory mechanics parameters, and pulmonary mechanical energy of patients in the conventional treatment group and ECCO2R group improved significantly after 24 hours of treatment compared to 12 hours of treatment (all P < 0.05). The levels of PaCO2, RSBI, total mechanical power, and non-dependent zone mechanical power in the ECCO2R group were significantly lower than those in the conventional treatment group at both 12 hours and 24 hours during the treatment [PaCO2 (mmHg, 1 mmHg ≈ 0.133 kPa): 44.03±2.96 vs. 49.96±2.50 at 12 hours, 41.65±3.21 vs. 48.53±2.33 at 24 hours; RSBI (times×min-1×L-1): 88.67±4.05 vs. 92.35±4.03 at 12 hours, 77.66±4.64 vs. 90.98±4.21 at 24 hours; total mechanical power (mJ): 10.40±1.15 vs. 12.93±1.68 at 12 hours, 11.13±1.18 vs. 14.05±1.69 at 24 hours; non-dependent zone mechanical power (mJ): 7.15±0.84 vs. 7.98±0.75 at 12 hours, 7.77±0.93 vs. 9.13±1.10 at 24 hours], and MEP and MIP in the ECCO2R group were significantly higher than those in the conventional treatment group at both 12 hours and 24 hours during the treatment [MEP (cmH2O, 1 cmH2O ≈ 0.098 kPa): 89.88±5.04 vs. 86.09±5.57 at 12 hours, 96.57±2.59 vs. 88.66±2.98 at 24 hours; MIP (cmH2O): 47.64±2.82 vs. 41.93±2.44 at 12 hours, 60.11±6.53 vs. 43.63±2.80 at 24 hours], the differences were statistically significant (all P < 0.05).
CONCLUSIONS:V-V ECCO2R combined with non-invasive ventilation can effectively reduce the regional tidal volume, mechanical power, and respiratory rate in the non-gravitational dependent zones of patients with mild to moderate ARDS, and improve respiratory distress and oxygenation status.
