Effect of high positive end-expiratory pressure for mechanical ventilation in the treatment of neurological pulmonary edema / 中华危重病急救医学

ABSTRACT

Objective To explore the effect of high positive end-expiratory pressure (PEEP) for the treatment of neurological pulmonary edema (NPE) in patients undergoing mechanical ventilation,and to look for the best mechanical ventilation strategy to improve the prognosis.Methods A prospective study was conducted,and 120 patients with NEP admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Guangxi Traditional Chinese Medical University from January 2010 to August 2013 were enrolled and divided into two groups according to random number table (n=60 in each group).The patients in two groups were given empiric treatment for the disease,and they underwent mechanical ventilation.In the normal PEEP group PEEP was 3-10 cmH2O (1 cmH2O =0.098 kPa),and in the high PEEP group PEEP was 11-30 cmH2O,and all the rest parameters were the same.Clinical indices before and 7 days after treatment,and 28-day morality rate were compared between two groups.Results The 28-day morality rate in high PEEP group was obviously lower than that in the normal PEEP group [25.0％ (15/60) vs.65.0％ (39/60),x2=6.465,P=0.011].The clinical signs in both groups were improved after treatment.Compared with the normal PEEP group,the clinical indices in high PEEP group were more significantly improved.There were significant differences in body temperature (℃ 37.4 ± 0.5 vs.38.5 ± 0.6),respiratory rate (times/min 18.3 ± 3.1 vs.23.3 ±3.5),heart rate (beats/min 94.7 ±8.5 vs.113.5 ±8.0),white blood cell count [WBC (× 109/L) 12.5 ±2.1 vs.17.1 ± 1.7],acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (15.6 ± 3.2 vs.19.8 ± 3.7),Glasgow coma score (GCS 12.5 ± 2.1 vs.8.5 ± 2.9),gastrointestinal dysfunction score (3.9 ± 3.0 vs.3.6 ± 2.4),oxygenation index [PaO2/FiO2 (mmHg,1 mmHg=0.133 kPa) 196.5 ± 45.1 vs.134.1 ± 22.3],serum creatinine [SCr (μmol/L) 86.5 ± 35.6 vs.98.5 ± 37.7],total bilirubin [TBil (μmol/L) 39.7 ± 23.5 vs.41.5 ± 16.2],C-reacting protein [CRP (mmol/L) 53.7 ± 21.4 vs.108.4 ± 26.3],prothrombin time [PT (s) 15.0 ± 2.1 vs.20.4 ± 2.2],activated partial thromboplastin time [APTT (s)37.3 ±4.9 vs.56.7 ± 13.6],international normalized ratio (INR 2.52 ±0.64 vs.4.01 ±0.77),extra vascular lung water index [EVLWI (mL/kg) 7.53 ± 1.21 vs.15.85 ±3.41],pulmonary vascular permeability index (PVPI 6.07 ± 0.89 vs.9.47 ± 1.26),mean arterial pressure [MAP (mmHg) 87.3 ± 10.9 vs.98.7 ± 13.6],cardiac output [CO (L/min) 7.15 ± 1.42 vs.5.65 ± 1.82],systemic vascular resistance index [SVRI (KP) 112.4 ± 9.5 vs.136.5 ± 11.9],and blood lactate (mmol/L2.53 ± 1.23 vs.5.81 ± 2.17) between high PEEP group and normal PEEP group (P＜0.05 or P＜0.01).Conclusion Prognosis can be improved in NPE patients with the use of high PEEP in mechanical ventilation.