在重症监护室进行气体体积校正:是必要的还是没有意义的?
Rosanna D'Albo1, Federica Romitti1, Luigi Camporota2
1Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany.
Journal of applied physiology (Bethesda, Md. : 1985)
|June 22, 2023
概括
气体体积校正对于在临床环境中准确测量二氧化碳清除量至关重要. 忽视这些情况可能会导致计算中的重大错误,影响机械通风和体外支持期间的患者治疗.
科学领域:
- 生理学 生理学 生理学
- 临界护理医学 临界护理医学
- 呼吸机械学 呼吸机械
背景情况:
- 呼吸气体体积在各种条件下 (STPD,ATPS,BTPS) 测量,这些条件在生理上是重要的,但在临床实践中经常被忽视.
- 精确评估呼吸和代谢变量对于在重症监护病房 (ICU) 中有效的患者管理至关重要.
研究的目的:
- 调查气体体积校正对关键呼吸和代谢变量的影响.
- 在计算中忽视气体体积条件的临床后果.
主要方法:
- 利用三个生理模型计算生理死空间,静脉添加剂和总二氧化碳产量 (V·co2).
- 在一个理论模型中,在448名患者中进行了带有和没有气体体积校正的计算.
- 专注于与体外支持和机械通风相关的变量.
主要成果:
- 缺少气体体积校正导致生理死空间分数的误差为0.05-0.15.
- 静脉混合物的计算显示了最小的误差 (0.01-0.04) 没有纠正.
- 在总二氧化碳产量 (V·co2tot) 中出现了显著的错误 (0%-18.4%),因为气体体积在体外支时没有得到纠正,这可能导致机械通风设置不正确.
结论:
- 气体体积校正对于准确的二氧化碳排放量评估至关重要,特别是在机械通风和体外支持期间.
- 纠正对于氧化评估来说不那么重要.
- 了解这些纠正的必要性可以改善患者状况评估和治疗量身定制.
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