基于电阻断层扫描或呼吸机械学的床边个性化方法,以在ARDS和招募与通胀比率中设置PEEP:一个生理学研究
Bertrand Pavlovsky1, Christophe Desprez2, Jean-Christophe Richard2
1Medical Intensive Care Unit, Vent'Lab, Angers University Hospital, University of Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France. bertrand.pavlovsky@gmail.com.
Annals of intensive care
|January 5, 2024
概括
在急性呼吸窘迫综合征 (ARDS) 患者中,不同的正极端呼吸压力 (PEEP) 定位策略产生了不同的PEEP水平. 没有一项经过测试的PEEP策略与肺部招募能力相关,这表明PEEP定位需要具体的招募能力评估.
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
- 医疗技术 医疗技术 医学技术
背景情况:
- 在急性呼吸窘迫综合征 (ARDS) 中优化正极端呼吸压力 (PEEP) 仍然是一个挑战.
- 有各种PEEP定位策略,包括使用电阻断断层扫描 (EIT) 和呼吸系统机械学的策略.
研究的目的:
- 将基于EIT的策略确定的PEEP水平与来自呼吸系统机制的PEEP水平进行比较.
- 评估PEEP水平与不同标位方法的肺部可招募性之间的关联.
主要方法:
- 十九名ARDS患者使用四种策略进行PEEP定位:Express (平原压力),Positive PLe (最小的阳性呼吸透气压力),Cov (通风中心) 和交叉点 (基于EIT的过张/崩曲线).
- 使用估计的招聘与通货膨胀比率 (R/Iest) 评估了招聘能力.
- 从20到5cmH2O进行了减量PEEP试验.
主要成果:
- 与积极PLe和交叉点策略相比,Express和Cov策略导致PEEP水平显著更高 (p <0.001).
- 根据任何策略确定的最佳PEEP水平与R/Iest之间没有发现显著的关联.
- 通过交叉点策略确定的PEEP水平受到减少试验中使用的PEEP范围的影响.
结论:
- 冠状病毒和快速策略的PEEP水平高于交叉点和积极PLe.
- 从这四种方法获得的PEEP水平与ARDS患者的肺部可招募性无关.
- 对招聘能力的具体评估对于优化ARDS中PEEP定位至关重要.
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