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Removal of a catheter mount and heat-and-moisture exchanger improves hypercapnia in patients with acute respiratory distress syndrome
http://hdl.handle.net/10069/00041098
http://hdl.handle.net/10069/00041098e7ba3021-3bf4-4c8e-abad-1f793f1df322
名前 / ファイル | ライセンス | アクション |
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Medicine100_e27199.pdf (403.9 kB)
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Item type | 学術雑誌論文 / Journal Article(1) | |||||
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公開日 | 2021-12-10 | |||||
タイトル | ||||||
タイトル | Removal of a catheter mount and heat-and-moisture exchanger improves hypercapnia in patients with acute respiratory distress syndrome | |||||
言語 | ||||||
言語 | eng | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | acute respiratory distress syndrome | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | dead space | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | heat-and-moisture exchanger | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | carbon dioxide | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | permissive hypercapnia | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | ventilation | |||||
資源タイプ | ||||||
資源タイプ識別子 | http://purl.org/coar/resource_type/c_6501 | |||||
資源タイプ | journal article | |||||
著者 |
Shimoda, Takaya
× Shimoda, Takaya× Sekino, Motohiro× Higashijima, Ushio× Matsumoto, Sojiro× Sato, Shuntaro× Yano, Rintaro× Egashira, Takashi× Araki, Hiroshi× Naoya, Iwasaki× Miki, Suzumura× Koyanagi, Ryo× Hayashi, Makoto× Kurihara, Shintaro× Hara, Tetsuya |
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抄録 | ||||||
内容記述タイプ | Abstract | |||||
内容記述 | To avoid ventilator-associated lung injury in acute respiratory distress syndrome (ARDS) treatment, respiratory management should be performed at a low tidal volume of 6 to 8 mL/kg and plateau pressure of ≤30 cmH2O. However, such lung-protective ventilation often results in hypercapnia, which is a risk factor for poor outcomes. The purpose of this study was to retrospectively evaluate the effectiveness and safety of the removal of a catheter mount (CM) and using heated humidifiers (HH) instead of a heat-and-moisture exchanger (HME) for reducing the mechanical dead space created by the CM and HME, which may improve hypercapnia in patients with ARDS. This retrospective observational study included adult patients with ARDS, who developed hypercapnia (PaCO2 > 45 mm Hg) during mechanical ventilation, with target tidal volumes between 6 and 8 mL/kg and a plateau pressure of ≤30 cmH2O, and underwent stepwise removal of CM and HME (replaced with HH). The PaCO2 values were measured at 3 points: ventilator circuit with CM and HME (CM + HME) use, with HME (HME), and with HH (HH), and the overall number of accidental extubations was evaluated. Ventilator values (tidal volume, respiratory rate, minutes volume) were evaluated at the same points. A total of 21 patients with mild-to-moderate ARDS who were treated under deep sedation were included. The values of PaCO2 at HME (52.7 ± 7.4 mm Hg, P < .0001) and HH (46.3 ± 6.8 mm Hg, P < .0001) were significantly lower than those at CM + HME (55.9 ± 7.9 mm Hg). Measured ventilator values were similar at CM + HME, HME, and HH. There were no cases of reintubation due to accidental extubation after the removal of CM. The removal of CM and HME reduced PaCO2 values without changing the ventilator settings in deeply sedated patients with mild-to-moderate ARDS on lung-protective ventilation. Caution should be exercised, as the removal of a CM may result in circuit disconnection or accidental extubation. Nevertheless, this intervention may improve hypercapnia and promote lung-protective ventilation. |
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書誌情報 |
Medicine 巻 100, 号 36, p. e27199, 発行日 2021-09-10 |
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出版者 | ||||||
出版者 | Wolters Kluwer Health, Inc. | |||||
ISSN | ||||||
収録物識別子タイプ | ISSN | |||||
収録物識別子 | 0025-7974 | |||||
DOI | ||||||
関連タイプ | isIdenticalTo | |||||
識別子タイプ | DOI | |||||
関連識別子 | 10.1097/MD.0000000000027199 | |||||
権利 | ||||||
権利情報 | © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 | |||||
著者版フラグ | ||||||
出版タイプ | VoR | |||||
出版タイプResource | http://purl.org/coar/version/c_970fb48d4fbd8a85 | |||||
引用 | ||||||
内容記述タイプ | Other | |||||
内容記述 | Medicine, 100(36), art. no. e27199; 2021 |