rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2007-6-157-163rmt-903Research ArticleПРАКТИКУЮЩЕМУ ВРАЧУFOR PRACTIONERПоложительное давление в конце выдоха и ингаляция оксида азота при лечении острого респираторного дистресс-синдромаPositive End-Expiratory Pressure and Nitric Oxide Inhalation in the Treatment of Acute Respiratory Distress SyndromeПопцовВ. Н.PoptsovV. N.КосолаповД. А.KosolapovD. A.МорозюкЕ. В.MorozyukYe. V.МошковА. С.MoshkovA. S.УхренковС. Г.UkhrenkovS. G.ФГУ НИИ трансплантологии и искусственных органов РОСЗДРАВА, МоскваResearch Institute of Transplantology and Artificial Organs, Russian Agency for Health Care, Moscow20072012200736Том III № 5-6 2007 г.157163Copyright © Попцов В.Н., Косолапов Д.А., Морозюк Е.В., Мошков А.С., Ухренков С.Г., 20072007Попцов В.Н., Косолапов Д.А., Морозюк Е.В., Мошков А.С., Ухренков С.Г.Poptsov V.N., Kosolapov D.A., Morozyuk Y.V., Moshkov A.S., Ukhrenkov S.G.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/903

Цель исследования — оценка влияния положительного давления в конце выдоха на гемодинамические и газообменные эффекты иNO у больных ОРДС.

Материалы и методы

Материалы и методы. В исследование включили 27 кардиохирургических больных с ОРДС, которые были разделены на 2 группы в зависимости от прироста (A) PaO2/FiO2 на фоне подачи иNO (5 ppm): APaO2/FiO2 > 15% (группа А, n=13) и APaO2/FiO2 < 15% (группа Б, n=14). Изучалось влияние различного уровня давления в конце выдоха (0, 4, 8, 12 и 16 см вод. ст.) на показатели газообменной функции лёгких, гемодинамики, транспорт-потребление О2, биомеханики дыхания на фоне и в отсутствие подачи иNO.

Результаты

Результаты. Без иNO у пациентов обеих групп выявлено увеличение (p<0,05) PaO2/FiO2 и торакопульмональной податливости при увеличении конечно-экспираторного давления с 0 до 8 см вод. ст. Повышение ПДКВ с 8 до 12 и 16 см вод. ст. в отсутствие подачи иNO не сопровождалось дальнейшим увеличением PaO2/FiO2 и торакопульмональной податливости. Только у пациентов группы А усиление влияния иNO на оксигенирующую функцию лёгких произошло при повышении конечно-экспираторного давления с 0 до 8 см вод. ст.: прирост PaO2/FiO2 на фоне подачи иNO увеличился (p<0,05), соответственно, с 21±3 до 38±6 мм рт. ст. Дальнейшее повышение ПДКВ до 12—16 см вод. ст. в этой группе не привело к усилению влияния иNO на артериальную оксигенацию.

Заключение

Заключение. Создание ПДКВ, сопровождаемое увеличением торакопульмональной податливости, усиливает действия иNO на оксигенирующую функцию лёгких только у больных, у которых применение иNO было эффективным и при нулевом конечно-экспираторном давлении.

 

 

Objective

Objective: to evaluate the impact of positive end-expiratory pressure (PEEP) on hemodynamic and gas-exchange effects of inhaled nitric oxide (iNO) in patients with acute respiratory distress syndrome (ARDS).

Subjects and methods

Subjects and methods. The study included 27 cardiosurgical patients with ARDS who were divided into 2 groups, depending on the increment (A) in PaO2/FiO2 during iNO delivery (5 ppm): A PaO2/FiO2 > 15% [Group A (n=13)] and APaO2/FiO2 < 15% [Group B (n=14)]. The impact of different end-expiratory pressures (0, 4, 8, 12, and 16 cm H2O) on the parameters of pulmonary gas-exchange function, hemodynamics, O2 transport-uptake, respiratory biomechanics in the presence and absence of iNO delivery was examined.

Results

Results. In Groups A and B patients receiving no iNO, there were increases in PaO2/FiO2 and thoracopulmonary compliance (p<0.05), with end-expiratory pressure being elevated from 0 to 8 cm H2O. The rise of PEEP from 8 to 12 and 16 cm H2O in the absence of iNO delivery was not further accompanied by increased PaO2/FiO2 and thoracopulmonary compliance. Only in Group A, the effect of iNO on pulmonary oxygenating function was potentiated with end-expiratory pressure being increased from 0 to 8 cm: the increment of PaO2/FiO2 during iNO delivery accordingly increased from 21±3 to 38±6 mm Hg. In this group, a subsequent increase of PEEP to 12—16 cm H2O did not lead to the enhanced effect of iNO on arterial oxygenation.

Conclusion

Conclusion. PEEP creation attended by increased thoracopulmonary compliance potentiates the effect of iNO on the pulmonary oxygenating function only in patients in whom the use of iNO is effective when end-expiratory pressure is zero.

 

 

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The authors declare that there are no conflicts of interest present.