■与传统的氧气设备相比,通过鼻插管的高流量氧气治疗(HFOT)已显示出临床益处。关于通过气管造口术在HFOT中是否也存在这种影响的数据有限。因此,我们旨在研究气管造口术对气管造口术长期机械通气患者膈肌功能和呼吸参数的短期影响。
■随机,交叉,我们于2020年12月至2021年4月在我们的ICU中对气管切开和长时间机械通气的患者进行了生理研究.患者进行了30分钟的自主呼吸试验(SBT),并通过T型或HFOT通过气管造口术接受了氧气,随后是通过T形件呼吸15分钟的冲洗期,并以随机交叉方式与其他方式接受30分钟的氧气。在每个会话的开始和结束时,血液气体,呼吸频率(f),通过赖特肺活量计测量潮气量(VT),随着隔膜超声检查,包括隔膜偏移和隔膜增厚部分,表示吸气肌肉的努力。
■招募了11名患者,其中19个疗程顺利完成;8名患者在不同的两天进行了两次研究,并交替进行了一次研究;3名患者进行了一次研究。患者被随机分配以T形片(n=10个疗程)或HFOT(n=9个疗程)开始SBT。有了HFOT,SBT期间室性心动过速和分钟通气量(VE)显著增加(从[465±119]mL增加到[549±134]mL,P<0.001,从[12.4±4.3]L/min到[13.1±4.2]L/min,分别P<0.05),但是在使用T形片的SBT期间,它们没有显着变化(从[495±132]mL到[461±123]mL,从[12.8±4.4]mL到[12.0±4.4]mL,分别);f/VT在HFOT期间降低(从[64±31]呼吸/(min•L)到[49±24]呼吸/(min•L),P<0.001),但在使用T形片的SBT期间,它没有显着变化(从[59±28]呼吸/(min•L)到[64±33]呼吸/(min•L));HFOT期间动脉血氧分压增加(从[99±39]mmHg到[132±48]mmHg,P<0.001),但是在使用T形片的SBT期间它减少了(从[124±50]mmHg到[83±22]mmHg,P<0.01)。此外,HFOT,膈肌偏移增加(从[12.9±3.3]mm增加到[15.7±4.4]mm,P<0.001),但在使用T形片的SBT期间,它没有显着变化(从[13.4±3.3]mm到[13.6±3.3]mm)。在使用T形片或HFOT的SBT过程中,the肌增厚分数均无变化。
■在长时间机械通气的患者中,通过气管造口术的HFOT与T形件相比改善了通气,呼吸模式,和氧合而不增加吸气肌肉的努力。
■Clinicaltrials.govldentifer:NCT04758910。
UNASSIGNED: Compared to conventional oxygen devices, high-flow oxygen treatment (HFOT) through the nasal cannulae has demonstrated clinical benefits. Limited data exist on whether such effects are also present in HFOT through tracheostomy. Hence, we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical ventilation.
UNASSIGNED: A randomized, crossover, physiological study was conducted in our ICU between December 2020 and April 2021, in patients with tracheostomy and prolonged mechanical ventilation. The patients underwent a 30-min spontaneous breathing trial (SBT) and received oxygen either via T-piece or by HFOT through tracheostomy, followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover manner. At the start and end of each session, blood gasses, breathing frequency (f), and tidal volume (VT) via a Wright\'s spirometer were measured, along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction, which expressed the inspiratory muscle effort.
UNASSIGNED: Eleven patients were enrolled in whom 19 sessions were uneventfully completed; eight patients were studied twice on two different days with alternate sessions; and three patients were studied once. Patients were randomly assigned to start the SBT with a T-piece (n=10 sessions) or with HFOT (n=9 sessions). With HFOT, VT and minute ventilation (VE) significantly increased during SBT (from [465±119] mL to [549±134] mL, P <0.001 and from [12.4±4.3] L/min to [13.1±4.2] L/min, P <0.05, respectively), but they did not change significantly during SBT with T-piece (from [495±132] mL to [461±123] mL and from [12.8±4.4] mL to [12.0±4.4] mL, respectively); f/VT decreased during HFOT (from [64±31] breaths/(min∙L) to [49±24] breaths/(min∙L), P <0.001), but it did not change significantly during SBT with T-piece (from [59±28] breaths/(min∙L) to [64±33] breaths/(min∙L)); partial pressure of arterial oxygen increased during HFOT (from [99±39] mmHg to [132±48] mmHg, P <0.001), but it decreased during SBT with T-piece (from [124±50] mmHg to [83±22] mmHg, P <0.01). In addition, with HFOT, diaphragmatic excursion increased (from [12.9±3.3] mm to [15.7±4.4] mm, P <0.001), but it did not change significantly during SBT with T-piece (from [13.4±3.3] mm to [13.6±3.3] mm). The diaphragmatic thickening fraction did not change during SBT either with T-piece or with HFOT.
UNASSIGNED: In patients with prolonged mechanical ventilation, HFOT through tracheostomy compared with T-piece improves ventilation, pattern of breathing, and oxygenation without increasing the inspiratory muscle effort.
UNASSIGNED: Clinicaltrials.gov ldentifer: NCT04758910.