在急性缺血性呼吸衰竭中,清醒的躺姿的生理效应
Domenico Luca Grieco1,2, Luca Delle Cese3,4, Luca S Menga3,4
1Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. dlgrieco@outlook.it.
Critical care (London, England)
|August 17, 2023
概括
清醒的倾向性定位可以改善低血症患者的氧化,但会增加灵感的努力. 建议在清醒时处于倾斜位置的患者有较高的呼吸力度,因为可能会导致自身造成的肺损伤.
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
- 肺部医学 肺部医学
背景情况:
- 急性缺血性呼吸衰竭 (AHRF) 需要了解呼吸模式的影响.
- 目醒易受影响的定位 (APP) 越来越多地用于AHRF患者.
- APP对呼吸机制的生理影响需要进一步研究.
研究的目的:
- 评估APP对AHRF患者呼吸模式的生理影响.
- 评估APP期间气体交换,呼吸力度和肺机械学的变化.
- 在接受高流量鼻氧的患者中,比较仰卧和倾斜的位置.
主要方法:
- 一项交叉试验涉及15名AHRF患者,PaO2/FiO2<200 mmHg.
- 患者在交替躺着和倾斜的姿势下接受高流量鼻氧.
- 测量包括动脉血液气体,食道压力,潮体积和通过电阻断层扫描的肺阻抗.
主要成果:
- 俯卧姿势显著改善了氧化 (PaO2/FiO2) 和降低了呼吸速率.
- 在倾斜的位置观察到增加的吸入力 (ΔPES) 和气道阻力.
- 俯卧姿势增强了对背部肺部区域的通风分布,减少了动态应变而不会改变肺部合规性.
结论:
- 清醒的倾向性定位可以改善氧化和改变AHRF患者的通风分布.
- 增加的呼吸道阻力和倾斜的呼吸力要求仔细考虑.
- 在APP期间,高吸气力可能需要谨慎预防自我造成的肺损伤.
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