在压力支通风过程中,患者的努力和驱动压力对协助变化的个体反应
Mattia Docci1, Emanuele Rezoagli1,2, Maddalena Teggia-Droghi2
1School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Annals of intensive care
|December 20, 2023
概括
接受机械通风的患者增加了他们的吸气力,以保持潮体积和驱动压力,当呼吸机支减少时. 在压力支通风期间,无论辅助水平如何,呼吸系统的符合性仍然可靠.
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:
- 压力支持通风 (PSV) 能够测量关键的呼吸系统参数,如平原压力 (Pplat),驱动压力 (∆P) 和呼吸系统合规性 (Crs).
- 压力-肌肉指数 (PMI) 估计了患者在PSV期间的鼓舞力.
研究的目的:
- 系统地评估患者的努力 (PMI),∆P和潮体积 (Vt) 对PSV变化的反应.
- 确认PSV期间Crs测量的可靠性.
主要方法:
- 研究了18名从PSV急性呼吸衰竭中恢复过来的患者.
- 与基线相比,交叉随机化为四个PSV援助水平 (+3, +6, -3, -6cmH2O).
- 吸入/呼气保持和非侵入性呼吸肌电肌图 (sEMG) 用于测量Pplat,PMI,∆P,Vt,Crs,P0.1和Pocc.
主要成果:
- 降低PSV导致Pplat和∆P的减少小于峰值气道压力,这是由于患者增加的努力 (PMI) 与隔膜sEMG相关.
- ∆P与Vt线性增加,而Crs在PSV水平上保持稳定 (P=0.119).
结论:
- 当PSV降低时,患者增加启发力 (PMI) 以保持目标Vt和∆P,从而限制临床医生的调制.
- PMI是识别呼吸器过度辅助的有价值指数.
- 在PSV期间的Crs测量似乎是可靠的,无论患者的辅助水平或患者的努力如何.
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