Anesth Analg:监测声门下二氧化碳水平以优化机械通气患者气管导管套囊压力:随机对照试验

2017-11-14 赵怀彪 “罂粟花”微信号

机械通气的许多并发症与气管插管(ETT)套囊压力不适当有关。 本研究的目的是评估长时间插管患者自动套囊压力闭环控制的有效性,其中声门下出现二氧化碳(CO2)作为泄漏指标。 研究的主要结果是使用CO2泄漏随时间曲线下的面积(AUC)量化的套囊周围渗漏量。

背景与目的:机械通气的许多并发症与气管插管(ETT)套囊压力不适当有关。 本研究的目的是评估长时间插管患者自动套囊压力闭环控制的有效性,其中声门下出现二氧化碳(CO2)作为泄漏指标。 研究的主要结果是使用CO2泄漏随时间曲线下的面积(AUC)量化的套囊周围渗漏量。

方  法:这是一项多中心,前瞻性,随机对照,非劣效性试验,包括重 症监护病房。 所有患者均插入AnapnoGuard ETT,其具有用于监测声门下空间中二氧化碳水平的 额外管腔。 研究组与AnapnoGuard系统连接,根据声门CO2(自动组)自动调整套囊控制。对照组连接到AnapnoGuard系统,套囊压力使用压力计3次/ d (手动组)手动管理。 由系统记录了两组袖带二氧化碳泄漏。

结  果:纳入了72名患者,最终分析了64名患者。 每小时套囊二氧化碳泄漏(mm Hg AUC / h)为0.22±0.32,自动组为0.09±0.04(P = 0.01),其中下限单侧95%置信区间为0.05,显示非劣效(> -0.033)。 另外,双侧95%置信区间为0.010至0.196,显示优势(> 0.0)。 自发组中显着的二氧化碳排泄(CO2> 2 mm Hg)为0.027±0.057(mm Hg AUC / h),手术组为0.296±0.784(mm Hg AUC / h)(P = 0.025)。 此外,自动组的套囊压力的97.6%在预定安全范围内,而自动组为48.2%  (P <.001)。

结  论:本研究表明,自动套囊压力组不仅具有非劣性而且比手动套囊压力组更优越。 因此,使用基于声门测量CO2水平的自动套囊压力控制是气管导管套囊压力优化的有效方法。 该方法是安全的,并且可以容易地与任何插管患者一起使用。

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    2018-01-22 amyloid
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    2018-10-25 heli0118
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  5. [GetPortalCommentsPageByObjectIdResponse(id=1775361, encodeId=92a61e75361aa, content=<a href='/topic/show?id=937d46650bf' target=_blank style='color:#2F92EE;'>#对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46650, encryptionId=937d46650bf, topicName=对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8ae138776909, createdName=amyloid, createdTime=Mon Jan 22 12:49:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1986176, encodeId=26f319861e603, content=<a href='/topic/show?id=239a6383520' target=_blank style='color:#2F92EE;'>#气管导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63835, encryptionId=239a6383520, topicName=气管导管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9dd613, createdName=xxxx1049, createdTime=Tue Apr 10 19:49:00 CST 2018, time=2018-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1700041, encodeId=558f1e00041c2, content=<a href='/topic/show?id=295524e541' target=_blank style='color:#2F92EE;'>#Anal#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2475, encryptionId=295524e541, topicName=Anal)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Thu Oct 25 21:49:00 CST 2018, time=2018-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1987193, encodeId=7e48198e193ab, content=<a href='/topic/show?id=bac5466546c' target=_blank style='color:#2F92EE;'>#对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46654, encryptionId=bac5466546c, topicName=对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, createdName=般若傻瓜, createdTime=Sun Aug 05 01:49:00 CST 2018, time=2018-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050921, encodeId=5ee3205092112, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Wed Sep 26 11:49:00 CST 2018, time=2018-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633407, encodeId=92f6163340e88, content=<a href='/topic/show?id=377824e1c0' target=_blank style='color:#2F92EE;'>#ANA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2471, encryptionId=377824e1c0, topicName=ANA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=434d22047430, createdName=AspirantSuo, createdTime=Sat Feb 03 00:49:00 CST 2018, time=2018-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1296180, encodeId=ec4a1296180e6, content=<a href='/topic/show?id=7591984530b' target=_blank style='color:#2F92EE;'>#随机对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98453, encryptionId=7591984530b, topicName=随机对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=373b263, createdName=lisa438, createdTime=Thu Nov 16 02:49:00 CST 2017, time=2017-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1465429, encodeId=09d014654299f, content=<a href='/topic/show?id=dedd23965cc' target=_blank style='color:#2F92EE;'>#二氧化碳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23965, encryptionId=dedd23965cc, topicName=二氧化碳)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=494e6728450, createdName=ewsr3, createdTime=Thu Nov 16 02:49:00 CST 2017, time=2017-11-16, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1775361, encodeId=92a61e75361aa, content=<a href='/topic/show?id=937d46650bf' target=_blank style='color:#2F92EE;'>#对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46650, encryptionId=937d46650bf, topicName=对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8ae138776909, createdName=amyloid, createdTime=Mon Jan 22 12:49:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1986176, encodeId=26f319861e603, content=<a href='/topic/show?id=239a6383520' target=_blank style='color:#2F92EE;'>#气管导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63835, encryptionId=239a6383520, topicName=气管导管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9dd613, createdName=xxxx1049, createdTime=Tue Apr 10 19:49:00 CST 2018, time=2018-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1700041, encodeId=558f1e00041c2, content=<a href='/topic/show?id=295524e541' target=_blank style='color:#2F92EE;'>#Anal#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2475, encryptionId=295524e541, topicName=Anal)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Thu Oct 25 21:49:00 CST 2018, time=2018-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1987193, encodeId=7e48198e193ab, content=<a href='/topic/show?id=bac5466546c' target=_blank style='color:#2F92EE;'>#对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46654, encryptionId=bac5466546c, topicName=对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, createdName=般若傻瓜, createdTime=Sun Aug 05 01:49:00 CST 2018, time=2018-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050921, encodeId=5ee3205092112, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Wed Sep 26 11:49:00 CST 2018, time=2018-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633407, encodeId=92f6163340e88, content=<a href='/topic/show?id=377824e1c0' target=_blank style='color:#2F92EE;'>#ANA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2471, encryptionId=377824e1c0, topicName=ANA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=434d22047430, createdName=AspirantSuo, createdTime=Sat Feb 03 00:49:00 CST 2018, time=2018-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1296180, encodeId=ec4a1296180e6, content=<a href='/topic/show?id=7591984530b' target=_blank style='color:#2F92EE;'>#随机对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98453, encryptionId=7591984530b, topicName=随机对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=373b263, createdName=lisa438, createdTime=Thu Nov 16 02:49:00 CST 2017, time=2017-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1465429, encodeId=09d014654299f, content=<a href='/topic/show?id=dedd23965cc' target=_blank style='color:#2F92EE;'>#二氧化碳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23965, encryptionId=dedd23965cc, topicName=二氧化碳)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=494e6728450, createdName=ewsr3, createdTime=Thu Nov 16 02:49:00 CST 2017, time=2017-11-16, status=1, ipAttribution=)]
    2018-02-03 AspirantSuo
  7. [GetPortalCommentsPageByObjectIdResponse(id=1775361, encodeId=92a61e75361aa, content=<a href='/topic/show?id=937d46650bf' target=_blank style='color:#2F92EE;'>#对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46650, encryptionId=937d46650bf, topicName=对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8ae138776909, createdName=amyloid, createdTime=Mon Jan 22 12:49:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1986176, encodeId=26f319861e603, content=<a href='/topic/show?id=239a6383520' target=_blank style='color:#2F92EE;'>#气管导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63835, encryptionId=239a6383520, topicName=气管导管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9dd613, createdName=xxxx1049, createdTime=Tue Apr 10 19:49:00 CST 2018, time=2018-04-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1700041, encodeId=558f1e00041c2, content=<a href='/topic/show?id=295524e541' target=_blank style='color:#2F92EE;'>#Anal#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2475, encryptionId=295524e541, topicName=Anal)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Thu Oct 25 21:49:00 CST 2018, time=2018-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1987193, encodeId=7e48198e193ab, content=<a href='/topic/show?id=bac5466546c' target=_blank style='color:#2F92EE;'>#对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46654, encryptionId=bac5466546c, topicName=对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ad9f79, createdName=般若傻瓜, createdTime=Sun Aug 05 01:49:00 CST 2018, time=2018-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050921, encodeId=5ee3205092112, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Wed Sep 26 11:49:00 CST 2018, time=2018-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633407, encodeId=92f6163340e88, content=<a href='/topic/show?id=377824e1c0' target=_blank style='color:#2F92EE;'>#ANA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2471, encryptionId=377824e1c0, topicName=ANA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=434d22047430, createdName=AspirantSuo, createdTime=Sat Feb 03 00:49:00 CST 2018, time=2018-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1296180, encodeId=ec4a1296180e6, content=<a href='/topic/show?id=7591984530b' target=_blank style='color:#2F92EE;'>#随机对照试验#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98453, encryptionId=7591984530b, topicName=随机对照试验)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=373b263, createdName=lisa438, createdTime=Thu Nov 16 02:49:00 CST 2017, time=2017-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1465429, encodeId=09d014654299f, content=<a href='/topic/show?id=dedd23965cc' target=_blank style='color:#2F92EE;'>#二氧化碳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23965, encryptionId=dedd23965cc, topicName=二氧化碳)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=494e6728450, createdName=ewsr3, createdTime=Thu Nov 16 02:49:00 CST 2017, time=2017-11-16, status=1, ipAttribution=)]
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