Julia Abram , Patrick Spraider , Julian Wagner , Manuela Ranalter , Alexandra Gratl , Daniela Lobenwein , Sabine Wipper , Gabriel Putzer , Tobias Hell , Pia Tscholl , Judith Martini
{"title":"猪失血性休克模型的负呼气末压力与零呼气末压力流量控制通气","authors":"Julia Abram , Patrick Spraider , Julian Wagner , Manuela Ranalter , Alexandra Gratl , Daniela Lobenwein , Sabine Wipper , Gabriel Putzer , Tobias Hell , Pia Tscholl , Judith Martini","doi":"10.1016/j.resplu.2025.101013","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Hemorrhagic shock is a life-threatening event whereby low flow may lead to end-organ dysfunction. This is aggravated by mechanical ventilation, where a positive intrathoracic pressure further deteriorates venous filling of the heart. The aim of this study was to evaluate the effects of a mild negative end-expiratory pressure (NEEP) on mean arterial pressure compared to zero end-expiratory pressure (ZEEP) in a porcine hemorrhagic shock model.</div></div><div><h3>Methods</h3><div>In anesthetized pigs, hemorrhagic shock was induced by a standardized lesion in the common femoral artery. After achieving half of baseline arterial pressure, hemorrhage was stopped. Ventilation was then switched to either flow-controlled ventilation with ZEEP (0 cmH<sub>2</sub>O, <em>n</em> = 6) or NEEP (−5 cmH<sub>2</sub>O, <em>n</em> = 6). After 5 min, fluid resuscitation was initiated (30 ml/kg) over 60 min and the observation period ended after 120 min.</div></div><div><h3>Results</h3><div>The primary outcome parameter mean arterial pressure was significantly improved within the first 15 min with NEEP compared to ZEEP (49 vs 40 mmHg, MD 9 (95% CI 2 to 15); <em>p</em> = 0.031), but this effect diminished throughout fluid resuscitation. The cardiac index was similar in both groups. Evaluation of lung mechanics revealed a decrease in dynamic compliance (29 vs 44 ml/cmH<sub>2</sub>O, MD −14 (95% CI −20 to −9); <em>p</em> < 0.001) in the NEEP group without differences in gas exchange.</div></div><div><h3>Conclusions</h3><div>Application of −5 cmH<sub>2</sub>O NEEP improved mean arterial pressure but not cardiac index during hemorrhagic shock and the first 15 min of fluid resuscitation compared to ZEEP. Thereby gas exchange performance was similar.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"25 ","pages":"Article 101013"},"PeriodicalIF":2.4000,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Negative end-expiratory versus zero end-expiratory pressure flow-controlled ventilation in a porcine hemorrhagic shock model\",\"authors\":\"Julia Abram , Patrick Spraider , Julian Wagner , Manuela Ranalter , Alexandra Gratl , Daniela Lobenwein , Sabine Wipper , Gabriel Putzer , Tobias Hell , Pia Tscholl , Judith Martini\",\"doi\":\"10.1016/j.resplu.2025.101013\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Hemorrhagic shock is a life-threatening event whereby low flow may lead to end-organ dysfunction. This is aggravated by mechanical ventilation, where a positive intrathoracic pressure further deteriorates venous filling of the heart. The aim of this study was to evaluate the effects of a mild negative end-expiratory pressure (NEEP) on mean arterial pressure compared to zero end-expiratory pressure (ZEEP) in a porcine hemorrhagic shock model.</div></div><div><h3>Methods</h3><div>In anesthetized pigs, hemorrhagic shock was induced by a standardized lesion in the common femoral artery. After achieving half of baseline arterial pressure, hemorrhage was stopped. Ventilation was then switched to either flow-controlled ventilation with ZEEP (0 cmH<sub>2</sub>O, <em>n</em> = 6) or NEEP (−5 cmH<sub>2</sub>O, <em>n</em> = 6). After 5 min, fluid resuscitation was initiated (30 ml/kg) over 60 min and the observation period ended after 120 min.</div></div><div><h3>Results</h3><div>The primary outcome parameter mean arterial pressure was significantly improved within the first 15 min with NEEP compared to ZEEP (49 vs 40 mmHg, MD 9 (95% CI 2 to 15); <em>p</em> = 0.031), but this effect diminished throughout fluid resuscitation. The cardiac index was similar in both groups. Evaluation of lung mechanics revealed a decrease in dynamic compliance (29 vs 44 ml/cmH<sub>2</sub>O, MD −14 (95% CI −20 to −9); <em>p</em> < 0.001) in the NEEP group without differences in gas exchange.</div></div><div><h3>Conclusions</h3><div>Application of −5 cmH<sub>2</sub>O NEEP improved mean arterial pressure but not cardiac index during hemorrhagic shock and the first 15 min of fluid resuscitation compared to ZEEP. Thereby gas exchange performance was similar.</div></div>\",\"PeriodicalId\":94192,\"journal\":{\"name\":\"Resuscitation plus\",\"volume\":\"25 \",\"pages\":\"Article 101013\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-06-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Resuscitation plus\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S266652042500150X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Resuscitation plus","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S266652042500150X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景:出血性休克是危及生命的事件,低血流可导致终末器官功能障碍。机械通气加重了这种情况,胸内正压进一步恶化心脏静脉充盈。本研究的目的是评估轻度呼气末负压(NEEP)与零呼气末压(ZEEP)对猪失血性休克模型平均动脉压的影响。方法麻醉猪采用股总动脉标准化病变诱发失血性休克。在达到基线动脉压的一半后,止血。然后将通气切换到ZEEP (0 cmH2O, n = 6)或NEEP (- 5 cmH2O, n = 6)的流量控制通气。5分钟后,在60分钟内开始液体复苏(30 ml/kg),观察时间在120分钟后结束。结果与ZEEP相比,NEEP的主要结局参数平均动脉压在前15分钟内显著改善(49 vs 40 mmHg, MD 9 (95% CI 2 ~ 15);P = 0.031),但在整个液体复苏过程中,这种效应减弱。两组心脏指数相似。肺力学评估显示动态顺应性降低(29 vs 44 ml/cmH2O, MD−14 (95% CI−20至−9);p & lt;0.001),在NEEP组中没有气体交换差异。结论与ZEEP相比,−5 cmH2O NEEP可改善失血性休克和液体复苏前15分钟的平均动脉压,但不能改善心脏指数。因此,气体交换性能是相似的。
Negative end-expiratory versus zero end-expiratory pressure flow-controlled ventilation in a porcine hemorrhagic shock model
Background
Hemorrhagic shock is a life-threatening event whereby low flow may lead to end-organ dysfunction. This is aggravated by mechanical ventilation, where a positive intrathoracic pressure further deteriorates venous filling of the heart. The aim of this study was to evaluate the effects of a mild negative end-expiratory pressure (NEEP) on mean arterial pressure compared to zero end-expiratory pressure (ZEEP) in a porcine hemorrhagic shock model.
Methods
In anesthetized pigs, hemorrhagic shock was induced by a standardized lesion in the common femoral artery. After achieving half of baseline arterial pressure, hemorrhage was stopped. Ventilation was then switched to either flow-controlled ventilation with ZEEP (0 cmH2O, n = 6) or NEEP (−5 cmH2O, n = 6). After 5 min, fluid resuscitation was initiated (30 ml/kg) over 60 min and the observation period ended after 120 min.
Results
The primary outcome parameter mean arterial pressure was significantly improved within the first 15 min with NEEP compared to ZEEP (49 vs 40 mmHg, MD 9 (95% CI 2 to 15); p = 0.031), but this effect diminished throughout fluid resuscitation. The cardiac index was similar in both groups. Evaluation of lung mechanics revealed a decrease in dynamic compliance (29 vs 44 ml/cmH2O, MD −14 (95% CI −20 to −9); p < 0.001) in the NEEP group without differences in gas exchange.
Conclusions
Application of −5 cmH2O NEEP improved mean arterial pressure but not cardiac index during hemorrhagic shock and the first 15 min of fluid resuscitation compared to ZEEP. Thereby gas exchange performance was similar.