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| Influence of positive end-expiratory pressure in different levels on hemodynamics in patients with acute respiratory distress syndrome |
| YE Yong-shun1 LI Wen-feng2 LIU Hua1▲ |
1.Department of Health Prevention for Cadres,the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou510000,China;
2.Department of Intensive Care Unit,the First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou510000,China |
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Abstract Objective To explore the effect of positive end-expiratory pressure(PEEP)in different levels on hemodynamics in patients with acute respiratory distress syndrome(ARDS).Methods 36 ARDS patients from July 2014 to July 2015 were admitted into our intensive care unit in our hospital and were selected.All patients were treated with invasive mechanical ventilation.According to different levels of PEEP in the process of invasive mechanical ventilation,they were evenly divided into low PEEP group(＞5-8 cmH2O),medium PEEP group(＞8-12 cmH2O),and high PEEP group(＞12-16 cmH2O) respectively.Centralvenous pressure(CVP),mean arterial pressure(MAP),and heart rate 24 hours before and after treatment were compared between three groups.Additionally,inter-group difference of ΔCVP,ΔMAP,andΔHR before and after therapy was compared.Results Among comparisons of CVP,MAP and HR were compared before and after therapy, when application of PEEP,the CVP level were higher than these before treatment with statistical difference(P＜0.01).The levels of MAP and HR were lower than those before treatment after using PEEP,which were displayed statistical difference(P＜0.01).In comparison of ΔCVP and ΔMAP,the index in the high PEEP group was greatly larger than that of low PEEP group with statisticant difference(P＜0.05).There was no great obvious difference in ΔHR among the groups(P＞0.05).Conclusion With the increase of PEEP levels,the effect of invasive mechanical ventilation on hemodynamics in ARDS patients also increases accordingly.
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| [1] |
尹俊，白春学.机械通气在急性呼吸窘迫综合征中的应用进展[J].中国急救医学，2014，34（2）：100-103.
|
| [2] |
Faneli V，Vlachou A，Ghannadian S，et al.Acute respiratory distress syndrome：new definition，current and future therapeutic options[J].J Thorac Dis，2013，5（3）：326-334.
|
| [3] |
Chikhani M，Das A，Haque M，et al.High PEEP in acute respiratory distress syndrome：quantitative evaluation between improved arterial oxygenation and decreased oxygen delivery[J].Br J Anaesth，2016，117（5）：650-658.
|
| [4] |
Meade MO，Cook DJ，Guyatt GH，et al.Ventilation strategy using low tidal volumes，recruitment maneuvers，and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome：a randomized controlled trial[J].JAMA，2008，299（6）：637-645.
|
| [5] |
Mercat A，Richard JC，Vielle B，et al.Positive end—expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome：a randomized controlled trial[J].JAMA，2008，299（6）：646-655.
|
| [6] |
DasenbrookEC，NeedhamDM，BrowerRG，etal.Higher PEEP in patients with acute lung injury：a systematic review and meta-analysis[J].Respir Care，2011，56（5）：568-575.
|
| [7] |
Brower RG，Lankan PN，MacIntyre N，et al.Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome[J].N Engl J Med，2004，351（4）：327-336.
|
| [8] |
Laffey JG，Bellani G，Pham T，et al.Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome：the lung safe study[J].Intensive Care Med，2016，42（12）：1865-1876.
|
| [9] |
Pintado MC，de Pablo R，Trascasa M，et al.Individualized PEEP setting in subjects with ARDS：a randomized controlled pilot study[J].Respir Care，2013，58（9）：1416-1423.
|
| [10] |
Pintado MC，de Pablo R，Trascasa M，et al.Complianceguided versus FiO2-driven positive-end expiratory pressure in patients with moderate or severe acute respiratory distress syndrome according to the Berlin definition[J].Med Intensiva，2016，PMID：27776936.
|
| [11] |
Rittayamai N，Brochard L.Recent advances in mechanical ventilation in patients with acute respiratory distress syndrome[J].Eur Respir Rev，2015，24（135）：132-140.
|
| [12] |
Albaiceta GM，Blanch L.Beyond volutrauma in ARDS：the critical role of lung tissue deformation[J].Crit Care，2011，15（2）：304.
|
| [13] |
Pierrakosa C，Karanikolasb M，Scolletta S，et al.Acute respiratory distress syndrome：pathophysiology and therapeutic options[J].J Clin Med Res，2012，4（1）：7-16.
|
| [14] |
Wiesen J，Ornstein M，Tonelli AR，et al.State of the evidence：mechanical ventilation with PEEP in patients with cardiogenic shock[J].Heart，2013，99（24）：1812-1817.
|
|
|
|
