潮肺歇斯底里分析以解释PEEP诱导的ARDS患者遵守规则的变化
Francesco Mojoli1,2, Marco Pozzi3, Eric Arisi3
1Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia, University of Pavia, Pavia, Italy. francesco.mojoli@unipv.it.
Critical care (London, England)
|June 13, 2023
概括
潮歇斯底里斯评估改善了对急性呼吸困扰综合征 (ARDS) 患者的阳性终端呼气压 (PEEP) 试验的解释. 这种方法有助于限制机械通风期间的肺部招募和能量损失.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统生理学 呼吸系统生理学
- 机械通风机械通风机械通风
背景情况:
- 在ARDS中,积极的终端呼气压 (PEEP) 选择通常针对最好的呼吸系统符合性.
- 潮内招募可以错误地提高合规性,掩盖潜在的机械问题.
- 潮肺歇斯底里为解释PEEP定位期间的合规性变化提供了更可靠的指标.
研究的目的:
- 为了评估ARDS患者的潮招募.
- 测试使用潮歇斯底里和合规性来解释下降PEEP试验的综合方法.
- 优化PEEP设置以改善患者的治疗结果.
主要方法:
- 在38名中度至重度COVID-19 ARDS患者中进行了减小PEEP试验.
- 在每个PEEP级别进行了低流通胀-通缩机动,以测量潮歇斯底里和遵守.
- 根据观察到的潮歇斯底里斯模式来对患者进行分类.
主要成果:
- 确定了三种潮歇斯底里模式:持续高 (26%),持续低 (32%) 和双相 (42%).
- 降低PEEP导致了82%的步骤的合规性增加,往往增加了潮歇斯底里.
- 综合方法建议基于歇斯底里模式的不同PEEP调整,与最佳合规方法 (不良协议,K=0.024) 有显著差异.
- 通过综合方法选择的PEEP导致了较低的潮歇斯底里和消散的能量.
结论:
- 评估潮歇斯底里斯可以提高对ARDS中减量PEEP试验的解释.
- 这种方法可以帮助减轻潮招募,并减少机械通风期间的能量消耗.
- 潮歇斯底里≥100毫升是PEEP减少期间潮招募的强有力的预测指标.
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