启发性上升时间对压力控制通风中的机械功率计算的影响:动态方法
Özlem Acicbe1, Canan Yazıcı Özgür2, Payam Rahimi2
1Department of Anesthesiology and Reanimation, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Intensive care medicine experimental
|December 20, 2023
概括
使用动态 (MPdyn) 和线性模型 (MPLM) 方程进行机械功率计算,在COVID-19 ARDS患者中显示出强烈的相关性. 差异在临床上并不显著,使MP成为机械通风期间持续监测的实际选择.
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
- 生物医学工程 生物医学工程
背景情况:
- 机械功率是通风引起的肺损伤的关键预测因素.
- 计算机械功率的现有方程包括线性模型 (MPLM) 和动态 (MPdyn) 方法.
- MPLM接近压力控制通风 (PCV) 的参考方法,而MPdyn使用自动测量呼吸的通风工作 (WOBv).
研究的目的:
- 在COVID-19急性呼吸困扰综合征 (C-ARDS) 患者中,使用MPLM和MPdyn方程进行机械功率计算的比较.
- 为了评估不同的灵感上升时间 (T斜率) 对机械功率计算的影响.
- 确定两个方程之间的差异和各种T斜率设置之间的临床意义.
主要方法:
- 在C-ARDS患者中,使用MPLM和MPdyn等式计算机械功率.
- 启发性上升时间 (T斜率) 在5%的间隔内从5%到20%变化.
- 使用单变量线性回归和布兰德-阿尔特曼分析来比较方程并评估差异.
主要成果:
- 在MPdyn和MPLM等式中,在不同的吸入到呼出 (I:E) 比率和T斜率值中显示出强烈的相关性 (R2>0.96).
- 布兰德-阿尔特曼分析显示,方程之间的平均差异具有统计学意义,但在临床上无意义 (平均值为-0.42 ± 0.41 J/min,所有测量为-0.39 ± 0.57 J/min).
- 如果T斜率增加了5%,则机械功率下降约为1J/分钟.
结论:
- 在MPdyn和MPLM等式之间的机械功率值的差异在临床上并不显著.
- 在PCV模式下,MPdyn是实用和连续的机械功率估计的可行选择.
- 增加T 斜率 持续时间导致计算机械功率的临床相关下降.
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