流量限制和反向触发的通风器失调与增加的潮和动态肺透气压力有关
Peter D Sottile1, Bradford Smith2,3, Jake N Stroh2
1Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO.
Critical care medicine
|January 12, 2024
概括
某些呼吸器失调,如双重触发的呼吸,显著增加肺部的压力和紧张. 然而,PEEP和镇静策略并不能减轻这些风险,强调需要进一步研究异步管理.
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:
- 呼吸机失调会增加肺部的压力和应变,即使在低潮通风时也是如此.
- 了解特定的异步类型及其对肺机制的影响对于患者的治疗结果至关重要.
研究的目的:
- 为了确定哪种类型的呼吸机失调最显著地增加了输送的潮体积 (Vt) 和动态透气压力 (ΔPL,dyn).
- 调查通风或镇静策略是否可以减轻与异步相关的肺压力和应变.
主要方法:
- 来自35名有ARDS或ARDS风险因素的ICU患者的超过58万次呼吸的前性队列分析.
- 利用食道计量和机器学习算法来识别10种类型的呼吸器失调.
- 采用混合效应模型来分析异步类型和肺应力/应变标记 (Vt,ΔPL,dyn,机械能) 之间的关联.
主要成果:
- 双触发呼吸最强烈地与增加的Vt,ΔPL,dyn和能量有关.
- 流量有限,早期逆转触发和早期呼吸器终止的呼吸也显著增加了这些指标.
- 增加设置Vt可能会在双重触发呼吸期间不成比例地增加肺部压力;PEEP和镇静剂没有改变这些关联.
结论:
- 特定的呼吸器失调 (双触发,流量限制,早期反向触发,早期呼吸器终止) 会增加肺部的压力和应变.
- 流量限制的呼吸更为常见,需要进一步调查它们对临床结果的累积影响.
- 目前的PEEP和镇静策略似乎无法减轻与呼吸器失调相关的风险.
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