在辅助机械通风过程中呼吸系统合规性计算的可靠性:一项回顾性研究
Luca Bastia1, Liliana Amendolagine2, Federico Pozzi1
1Neurointensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Critical care medicine
|June 16, 2023
概括
在辅助机械通风 (MV) 过程中,当平原压力 (Pplat) 稳定时,呼吸系统合规性 (Crs) 计算是可靠的. 这一发现支持在接受呼吸器支持的重症患者中进行准确的监测.
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:
- 精确计算呼吸系统合规性 (Crs) 是优化机械通风 (MV) 的关键.
- 与受控MV相比,在辅助MV期间确定可靠的Crs测量具有独特的挑战.
- 平原压力 (Pplat) 是Crs计算的关键参数,但其稳定性在通风模式之间可能有所不同.
研究的目的:
- 为了比较控制机械通风 (MV) 和辅助MV期间的呼吸系统合规性 (Crs) 的计算.
- 评估在辅助MV过程中获得的Crs测量的可靠性.
- 为了评估平原压力 (Pplat) 稳定性对不同MV模式中的Crs计算的影响.
主要方法:
- 一项追溯观察性研究对101名在神经ICU的成年患者进行了观察.
- 使用呼吸暂停计算Crs和驱动压力,以在60分钟内在受控和辅助MV中确定Pplat.
- 如果Pplat视觉稳定至少2秒,则被认为可靠.
主要成果:
- 在受控和辅助MV (Bland-Altman偏差 -3.9) 中的Crs测量之间发现了可接受的协议.
- 在辅助MV中的Crs为64.1mL/cmH2O,在受控MV中的Crs为61.2mL/cmH2O (p=0.006).
- 在Crs中没有观察到统计差异,无论峰值吸气压低于Pplat还是高于Pplat.
结论:
- 视觉稳定的Pplat至少2秒,确保在辅助MV期间可靠的Crs计算.
- 这一发现证实了Pplat测量用于Crs计算在辅助MV中的使用.
- 该研究支持在不同的机械通风模式中进行一致的Crs监测.
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