Hemodynamic Consequence of Hand Ventilation Versus Machine Ventilation During Transport After Cardiac Surgery

E. OʼBrien, Beverly Newhouse, B. Cronin, K. Robbins, A. Nguyen, S. Khoche, Ulrich H. Schmidt
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Abstract

Manual hand ventilation and portable machine ventilation are both widely used during in-hospital transport of intubated patients following surgery, but the comparative safety and reliability of each mode of ventilation are still unclear. This prospective randomized study aimed at examining the hemodynamic consequences of manual and portable ventilation during transport from the operating room (OR) to the intensive care unit (ICU) in intubated patients following cardiac surgery. The study also hypothesized that manual ventilation after cardiac surgery would result in greater changes in measured end-tidal carbon dioxide (ETCO2) and pulmonary artery (PA) pressure when compared to machine ventilation. The study data were composed of 36 cardiac surgery patients with planned intubation during transport to the ICU. Following surgery, the patients were randomized into 2 cohorts to receive either manual ventilation (with a self-inflating bag-valve resuscitator) or machine ventilation (attached to a portable transport ventilator) during in-hospital transport. Hand ventilation was done by the anesthesiologist who provided care during surgery, and machine ventilation was set by a respiratory therapist to match parameters in the OR at the end of the case. Hemodynamic variables, ETCO2, and PA pressures before and during transport and upon arrival in the ICU were recorded. A 2-sided, unpaired t test was used to determine differences between values, and a threshold P < 0.05 was considered statistically significant. The 3 study outcomes measured were the difference from baseline ETCO2, hemodynamic changes from baseline, and changes in PA pressure before and after transport. There was no difference in transport time between hand-ventilated (mean, 5 ± 1.41 minutes) and machine-ventilated (mean, 5.47 ± 1.74 minutes) patients (P = 0.369). The transport ETCO2 excursion was significantly different between hand-ventilated (5.44) and machineventilated patients (2.32, P = 0.0126), but the total ETCO2 excursion was not significant (P = 0.066). These differences were not associated with a difference inmean PA pressure. No differences were found in mean arterial pressure, heart rate, or SpO2 (ICU vs OR). In conclusion, manual ventilation was associated with greater changes from baseline ETCO2 than machine ventilation during transport after cardiac surgery, but these differences were not associated with changes in mean PA pressure, vital signs, oxygen saturation, or heart rhythm upon arrival at ICU. The results do not support routine use of a transport ventilator in patients transported after cardiac surgery.
心脏手术后运输过程中手通气与机器通气的血流动力学影响
人工手通气和便携式机器通气在手术后插管患者的院内转运中均被广泛使用,但每种通气方式的相对安全性和可靠性尚不清楚。本前瞻性随机研究旨在研究心脏手术后插管患者从手术室(OR)转移到重症监护病房(ICU)期间手动和便携式通气对血液动力学的影响。该研究还假设,与机器通气相比,心脏手术后人工通气会导致测量的潮末二氧化碳(ETCO2)和肺动脉(PA)压力发生更大的变化。研究数据由36例在转运至ICU期间计划插管的心脏手术患者组成。手术后,患者被随机分为2组,在院内运输过程中接受人工通气(使用自充气袋阀复苏器)或机器通气(连接便携式运输呼吸机)。手术期间提供护理的麻醉师进行手通气,呼吸治疗师设置机器通气以匹配病例结束时手术室的参数。记录患者在转运前、转运中及抵达ICU时的血流动力学变量、ETCO2和PA压。采用双侧、非配对t检验来确定数值之间的差异,阈值P < 0.05认为具有统计学意义。测量的3个研究结果是与基线ETCO2的差异,与基线的血流动力学变化,以及运输前后PA压的变化。手工通气患者转运时间(平均5±1.41 min)与机器通气患者转运时间(平均5.47±1.74 min)差异无统计学意义(P = 0.369)。手动通气患者转运ETCO2漂移(5.44)与机器通气患者转运ETCO2漂移(2.32,P = 0.0126)差异有统计学意义,但总ETCO2漂移无统计学意义(P = 0.066)。这些差异与平均PA压的差异无关。在平均动脉压、心率或SpO2 (ICU vs or)方面没有发现差异。综上所述,在心脏手术后的运输过程中,人工通气与基线ETCO2相比有更大的变化,但这些差异与到达ICU时平均PA压、生命体征、血氧饱和度或心律的变化无关。结果不支持在心脏手术后运送的患者中常规使用运输呼吸机。
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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