Closed-loop ventilation and oxygenation with decision support fluid resuscitation to treat major burn injury with smoke induced acute respiratory distress syndrome.

IF 2.7 3区医学 Q2 CRITICAL CARE MEDICINE

SHOCK Pub Date : 2025-01-22 DOI:10.1097/SHK.0000000000002552

Ryuichiro Kakizaki, Satoshi Fukuda, Keibun Liu, Kan Nakamoto, Tsend-Ayush Batsaikhan, Muzna N Khan, Richard D Branson, Michael P Kinsky, Perenlei Enkhbaatar

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引用次数: 0

Abstract

Introduction: The understanding of the interaction of closed-loop control of ventilation and oxygenation, specifically fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP), and fluid resuscitation after burn injury and acute lung injury from smoke inhalation is limited. We compared the effectiveness of FiO2, PEEP, and ventilation adjusted automatically using adaptive support ventilation (ASV) and decision support fluid resuscitation based on urine output in a clinically relevant conscious ovine model of lung injury secondary to combined smoke inhalation and major burn injury.

Methods: Sheep were subjected to burn and smoke inhalation injury under deep anesthesia and analgesia. After injury, sheep were randomly allocated to two groups. 1) Closed-loop group: automated mechanical ventilation (ASV), oxygen FiO2 and PEEP (n = 9); and 2) Control group: mechanically ventilated with standard ASV mode (n = 8). FiO2, PEEP, and the percentage of the minute volume (%MV) were automatically adjusted in group 1, whereas PEEP was held at 5 cmH2O, and FiO2 and %MV were manually adjusted in group 2. Decision support fluid resuscitation was guided based on urine output. Cardiopulmonary hemodynamics were monitored for 48 h.

Results: There were no differences in body weight and the severity of smoke injury between the two groups. The Closed-loop group resulted in significantly higher PEEP, %MV, static lung compliance, and survival rate; the driving pressure was significantly lower compared to the Control group. In the Closed-loop group, the net fluid balance at 48 h was significantly greater than in the Control group.

Conclusion: Closed-loop ventilation and oxygenation with decision support fluid resuscitation improve lung mechanics and survival in sheep with combined burn and smoke inhalation. There were no negative interactions observed between automated PEEP control and fluid management.

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闭环通气加氧联合决策支持液体复苏治疗重度烧伤伴烟雾性急性呼吸窘迫综合征。

引言：对通气和氧合闭环控制，特别是吸入氧分数（FiO2）和呼气末正压（PEEP）与烧伤和烟雾吸入急性肺损伤后液体复苏的相互作用的理解有限。我们比较了FiO2、PEEP、自适应支持通气（ASV）自动调节通气和基于尿量的决策支持液体复苏在临床相关的烟雾吸入合并严重烧伤继发肺损伤羊模型中的有效性。方法：在深度麻醉和镇痛下对绵羊进行烧伤和烟雾吸入性损伤。损伤后随机分为两组。1)闭环组：自动机械通气（ASV）、氧气FiO2、PEEP (n = 9)；2)对照组：采用标准ASV模式机械通气（n = 8）。1组自动调节FiO2、PEEP和分气量百分比（%MV）， 2组将PEEP保持在5 cmH2O，手动调节FiO2和%MV。决策支持液体复苏指导基于尿量。结果：两组大鼠体重及烟雾伤严重程度无明显差异。闭环组PEEP、%MV、静态肺顺应性和生存率显著提高；与对照组相比，驾驶压力明显降低。在闭环组中，48 h的净体液平衡明显大于对照组。结论：闭环通气加氧配合决策支持液体复苏可改善烧伤合并烟雾吸入羊的肺力学和生存率。在自动PEEP控制和流体管理之间没有观察到负面的相互作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

SHOCK 医学-外科

CiteScore

6.20

自引率

3.20%

发文量

199

审稿时长

1 months

期刊介绍： SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.