脑死亡中呼吸暂停测试的安全性:单中心回顾性队列分析

Talita Sansoni, Nicholas Nascimento, G. Franco, R. Moreno, A. Barros, V. Filho, H. Zambelli, Ana Paula Devite Cardoso Gasparotto, L. A. Sardinha, A. E. Falcão
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Descriptive statistical analyses of the numerical variables (such as pH, PaO 2 , PaCO 2 , HCO 3, SatO 2 ) with mean values and standard deviation, medians, and quartiles were performed. The Student’s t -test was used for pairwise group comparisons. A P < 0.05 level was adopted for significance. Results: Eighty-seven protocols were evaluated. The mean apnea test duration was 11 min. All of the patients were under vasoactive drugs. Only five apnea tests were interrupted before the end at 10 min due to rapid desaturation (SatO 2 < 90%), with no invalidated apnea test. 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引用次数: 0

摘要

背景:当最大高碳酸血症(paco2 > 55 mm Hg)呼吸中枢刺激后未观察到自发呼吸运动时,呼吸暂停测试被认为是阳性,在本研究中,通过评估2010年至2017年在坎皮纳斯大学(UNICAMP)重症监护室进行的脑死亡协议期间的血气分析,对该测试进行了严格评估。方法:基于重症监护病房和移植器官检索组织数据库进行回顾性队列分析。评估血气分析前(第一次和第二次呼吸暂停测试前)和后(第一次和第二次呼吸暂停测试后)。对数值变量(如pH、pao2、paco2、hco3、SatO 2)的平均值、标准差、中位数和四分位数进行描述性统计分析。两两组比较采用学生t检验。以P < 0.05为显著性水平。结果:共评估了87个方案。呼吸暂停测试的平均持续时间为11分钟。所有患者均服用血管活性药物。只有5次呼吸暂停测试在结束前10分钟因快速去饱和而中断(SatO 2 < 90%),没有无效的呼吸暂停测试。首次呼吸暂停试验前评估血气试验的平均值和标准差为:pH 7.35(±0.10),PaO 2 252.15 mm Hg(±114.11),PaCO 2 42.78 mm Hg(±10.84);第一次呼吸暂停试验后:pH 7.11(±0.08),PaO 2 208.39 mm Hg(±112),PaCO 2 82.43 mm Hg(±16.91);第二次试验前:pH 7.33(±0.09),pao2 253.56 mm Hg(±105.36),paco2 43.76 mm Hg(±9.67);第二次呼吸暂停测试后:pH 7.11(±0.10),PaO 2 200.1 mm Hg(±116.45),PaCO 2 84.98 mm Hg(±20.21)。第一次和第二次呼吸暂停试验前后的pH、pao2、paco2值差异有统计学意义(P < 0.0001)。结论:呼吸暂停测试是安全的,血气测试结果与文献中描述的相似,通过快速重新连接机械通气可预防严重低氧血症;呼吸暂停测试后发现明显的高碳酸血症和酸血症,但没有测试无效。J Neurol Res. 2021;000(000):000-000 doi: https://doi.org/10.14740/jnr646
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Apnea Test Safety in Brain Death: A Single-Center Retrospective Cohort Analysis
Background: The apnea test, which is considered positive when no spontaneous breathing movements are observed following maximal hypercapnia (PaCO 2 > 55 mm Hg) respiratory center stimulation, was critically evaluated in this study by assessment of blood gas analyses performed during brain death protocols from 2010 to 2017, in the intensive care units of the Universidade Estadual de Campinas (UNICAMP). Methods: A retrospective cohort analysis based on the intensive care unit and Transplant Organ Search Organization data banks. Blood gas analyses before (pre-first and -second apnea tests) as after (after-first and -second apnea tests) were assessed. Descriptive statistical analyses of the numerical variables (such as pH, PaO 2 , PaCO 2 , HCO 3, SatO 2 ) with mean values and standard deviation, medians, and quartiles were performed. The Student’s t -test was used for pairwise group comparisons. A P < 0.05 level was adopted for significance. Results: Eighty-seven protocols were evaluated. The mean apnea test duration was 11 min. All of the patients were under vasoactive drugs. Only five apnea tests were interrupted before the end at 10 min due to rapid desaturation (SatO 2 < 90%), with no invalidated apnea test. Mean and standard deviation of blood gas tests assessed before the first apnea test were: pH 7.35(± 0.10), PaO 2 252.15 mm Hg (± 114.11), PaCO 2 42.78 mm Hg (± 10.84); after the first apnea test: pH 7.11(± 0.08), PaO 2 208.39 mm Hg (± 112), PaCO 2 82.43 mm Hg (± 16.91); before the second test: pH 7.33 (± 0.09), PaO 2 253.56 mm Hg (± 105.36), PaCO 2 43.76 mm Hg (± 9.67); following the second apnea test: pH 7.11 (± 0.10), PaO 2 200.1 mm Hg (± 116.45), PaCO 2 84.98 mm Hg (± 20.21). The pH, PaO 2 , and PaCO 2 values before and after the first and second apnea tests have shown statistically significant differences (P < 0.0001). Conclusions: The apnea test was safe, blood gas test results are similar to those described in the literature, severe hypoxemias were prevented by a quick reconnection to the mechanical ventilation; and marked hypercapnia and acidemia following the apnea test were found, but no test was invalidated. J Neurol Res. 2021;000(000):000-000 doi: https://doi.org/10.14740/jnr646
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