探索基于表型的呼吸机参数优化以减轻术后肺部并发症:一个回顾性观察队列研究
Hideyo Tsumura1,2, Debra Brandon3,4, Charles Vacchiano3
1Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA. hideyo.tsumura@duke.edu.
Surgery today
|December 14, 2023
概括
确定了最佳的机械通风设置,包括潮体积 (VT) 和阳性末尾呼气压力 (PEEP),以尽量减少不同患者表型的术后肺并发症 (PPC).
科学领域:
- 麻醉学和重症监护医学
- 呼吸系统生理学 呼吸系统生理学
- 手术结果研究研究.
背景情况:
- 手术后的肺部并发症 (PPC) 是手术后发病率和死亡率的重要原因.
- 个性化的机械通风策略对于优化患者的治疗结果至关重要.
- 确定不同患者群体的特定呼吸器设置仍然是一个挑战.
研究的目的:
- 为了确定最佳的潮体积 (VT) 和正极呼吸压力 (PEEP),以减少PPC的发生率和严重程度.
- 根据术前特征对患者进行表型分层,以指导呼吸器管理.
- 确定VT和PEEP设置与每个已识别的表型的最佳结果相关.
主要方法:
- 对34,910名接受机械呼吸手术的成年患者进行了回顾性观察队列研究.
- 最小绝对收缩和选择操作员 (LASSO) 回归以确定关键的手术前预测因素.
- 用分类和回归树 (CART) 分析来定义患者的表型.
- 后勤回归和ROC曲线分析以确定每个表型的最佳VT和PEEP.
主要成果:
- 通过CART分析确定了七种不同的患者表型.
- 发展PPC的概率在不同表型 (3.51%至68.57%) 之间有很大差异.
- 确定了最佳VT (7-8毫升/公斤预测体重) 和PEEP (6-8厘米H2O) 以尽量减少所有表型的PPC和严重程度.
结论:
- 狭窄的VT和PEEP设置范围与PPC的发病率和严重程度最低相关.
- 这些最佳设置在不同的患者表型中似乎是一致的,尽管它们的风险概况各不相同.
- 这一发现表明,在外科手术期间,机械通风可能是一个普遍的方法.
更多相关视频
相关概念视频
Mechanical Ventilation I: Indication and Settings
400
Mechanical ventilation is a life-saving technique for managing acute respiratory failure and other respiratory complications. The process involves using a machine known as a ventilator to supply oxygen to the lungs and assist in removing carbon dioxide. It serves as a bridge to long-term mechanical ventilation or a temporary measure until ventilatory support is discontinued. The ventilator can maintain this function for a prolonged period, providing critical support for patients until they can...
400
Ventilatory Modes
161
Mechanical ventilators are life-saving devices that support or replace spontaneous breathing. They deliver breaths to patients through varying methods known as ventilator modes. Understanding these modes is critical for healthcare providers managing patients with respiratory failure.
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...
161
Mechanical Ventilation II: Invasive Ventilation
151
Ventilators are essential medical equipment used to aid patients with respiratory difficulties. Their primary function is to assist or replace spontaneous breathing by providing mechanical ventilation. There are two general classes of mechanical ventilators: negative-pressure and positive-pressure ventilators.
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
151
Mechanical Ventilation III: Noninvasive Ventilation
125
Noninvasive positive-pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) are essential methods in respiratory care. These ventilation techniques offer unique benefits for patients with various respiratory conditions, providing adequate support without requiring intubation. Let's explore how each method is crucial in improving patient outcomes and enhancing respiratory therapy.
Noninvasive Positive-Pressure Ventilation...
Noninvasive Positive-Pressure Ventilation...
125
Acute Respiratory Failure-V
142
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
142
Pneumonia V: Nursing management and Prevention
2.1K
Nursing management of pneumonia involves promoting airway patency, facilitating rest and conserving energy, encouraging fluid intake, maintaining nutrition, and educating patients.
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
2.1K


