驱动压肺保护性通气策略在危重型新型冠状病毒肺炎中的应用

Application of the strategy of driving pressure protective ventilation in critically ill patients with COVID-19

目的探讨小潮气量、限制驱动压在危重型新型冠状病毒肺炎(COVID-19)气管插管患者顺利脱机拔管中的应用效果,为临床医师提供诊疗经验。方法纳入COVID-19诊治过程中的气管插管患者6例,记录并分析患者基本资料、气管插管后的呼吸机模式、驱动压、呼吸末正压(PEEP)、血气分析、呼吸力学指标以及镇痛镇静药、抗病毒用药情况。结果有2例患者气管插管拔管成功,2例患者进行气管切开后脱机成功,2例患者死亡。结论小潮气量限制性驱动压滴定PEEP肺保护性的通气策略和以呼吸力学指标为指导的脱机策略是患者顺利脱机的关键环节。负平衡、适度镇痛镇静、目标血压控制也不容忽视。

Objective To investigate the strategy of driving pressure protective ventilation in critically ill patients procedures of tracheal extubation of patients with COVID-19 in our critical care unit and to provide clinical experience for reference. Methods 6 patients of COVID-19 with tracheal intubation were included. The basic data including ventilator mode, driving pressure, PEEP, blood gas analysis, respiratory mechanics index, fluid quantity of entry and exit, usage of analgesics and sedation, and antiviral medication were recorded. Results2 patients had successful extubation, 2 patients had successful removed ventilator after tracheotomy, and 3 patients died. Conclusion Small tidal volume titrating PEEP by protective lung ventilation strategy based on driving pressure and offline strategy guided by respiratory mechanics index, are the key points to successful removing breathing machine. Meanwhile, artificial liver therapy, fluid negative balance, moderate analgesia and sedation, target blood pressure control cannot allow to be ignored.