Heliox ventilation in elderly, hypertensive ICU patients improves microcirculation: A randomized controlled study

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE Journal of critical care Pub Date : 2024-08-12 DOI:10.1016/j.jcrc.2024.154897

Lili Zhou , Jing Lin , Mingkai Zhuang , Yue Wang , Qinyong Weng , Hui Zhang

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Abstract

Background

Conventional mechanical ventilation has adverse impacts on the hemodynamics of elderly, hypertensive ICU patients. Limited studies have addressed ways to ameliorate these negative effects. This study aimed to determine whether heliox ventilation could improve the hemodynamics, especially microcirculation, of elderly, hypertensive patients undergoing mechanical ventilation.

Methods

Thirty-eight patients, over the age of 65 with essential hypertension who underwent invasive mechanical ventilation treatment, were divided into two groups: a control group of nitrogen‑oxygen ventilation (n = 19) and an experimental group of heliox ventilation (n = 19). The control group received conventional room air ventilation and the experimental group adopted the innovative, closed heliox ventilation technique. Changes in blood pressure, heart rate (HR), peripheral oxygen saturation (SpO₂), central venous oxygen saturation (ScvO₂), regional cerebral oxygen saturation (rSO₂), lactic acid (Lac) and airway pressure were measured at 0,1,2,3 h under volume-controlled ventilation (VCV) mode throughout the study. Sublingual microcirculation parameters were additionally measured at 0 h and 3 h of ventilation treatment.

Results

SpO₂ in both groups increased after 1 h of ventilation compared with 0 h (p < 0.001), subsequently remaining stable. Compared with the control group, the experimental group showed a decrease in airway pressure and Lac, while blood pressure, ScvO₂, and rSO₂ increased (p < 0.05). Moreover, the sublingual microcirculation indexes in the experimental group improved compared with the control group (p < 0.05).

Conclusions

Heliox ventilation improves blood pressure and microcirculation in elderly hypertensive patients and may resolve the limitations of traditional nitrogen‑oxygen ventilation.

Trial registration

This trial was registered. The Chinese trial registration number is ChiCTR2100043945. The date of registration is 6-3-2021.

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对老年高血压重症监护病房患者进行 Heliox 通气可改善微循环：随机对照研究。

背景：传统的机械通气会对高龄、高血压 ICU 患者的血液动力学产生不利影响。关于如何改善这些负面影响的研究十分有限。本研究旨在确定氦氧通气是否能改善接受机械通气的老年高血压患者的血液动力学，尤其是微循环：将 38 名 65 岁以上接受有创机械通气治疗的原发性高血压患者分为两组：氮氧通气对照组（19 人）和氦氧通气实验组（19 人）。对照组接受传统的室内空气通气，实验组采用创新的封闭式螺旋氧通气技术。在整个研究过程中，在容量控制通气（VCV）模式下，分别于 0、1、2、3 h 测量血压、心率（HR）、外周血氧饱和度（SpO2）、中心静脉血氧饱和度（ScvO2）、区域脑血氧饱和度（rSO2）、乳酸（Lac）和气道压力的变化。此外，还在通气治疗的 0 小时和 3 小时测量了舌下微循环参数：结果：与 0 小时相比，通气 1 小时后两组患者的 SpO2 均有所增加（p 2），rSO2 也有所增加（p 结论：通气 3 小时后，两组患者的 SpO2 均有所增加（p 3），rSO2 也有所增加（p 4）：Heliox通气可改善老年高血压患者的血压和微循环，可解决传统氮氧通气的局限性：本试验已注册。中国试验注册号为 ChiCTR2100043945。注册日期为 6-3-2021。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.