积极的终端呼气压力通过调节努力与驱动的比率来限制吸气力度:一个实验性的交叉研究
Hannes Widing1,2, Mariangela Pellegrini3,4, Elena Chiodaroli3,5
1Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Akademiska sjukhuset, Ing 40, 3 tr, 751 85, Uppsala, Sweden. hannes.widing@outlook.com.
Intensive care medicine experimental
|February 4, 2024
概括
在急性呼吸窘迫综合征中,高阳性末尾呼气压 (PEEP) 降低了患者在自发呼吸过程中的努力. 这一发现表明PEEP可以帮助预防肺损伤,并促进更安全的辅助通风策略.
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:
- 在急性呼吸窘迫综合征 (ARDS) 中,辅助自发呼吸 (ASB) 的最佳使用仍在争论中.
- 新出现的证据表明,高阳性末尾呼气压 (PEEP) 可能减轻患者自我造成的肺损伤 (P-SILI).
研究的目的:
- 评估不同PEEP水平对食道压力波动,吸气动力和神经肌肉呼吸效率的影响.
- 为了测试提升PEEP的假设,通过调节努力与驱动的比率 (EDR) 来减少食道压力波动.
主要方法:
- 一项实验性动物交叉研究的回顾性分析,涉及麻醉猪 (n=15) 诱导肺损伤.
- 应用PEEP水平从0到15cmH2O,然后再以3cmH2O的增量回到0cmH2O.
- 测量气道压力,食道压力 (Pes) 和腹膜电活动 (Edi);计算EDR作为Pes的潮变化除以Edi的潮变化.
主要成果:
- 增加PEEP从0到15cmH2O显著减少了吸入性食道压力波动 (从-4.2±3.1到-1.9±1.5cmH2O,p<0.01).
- 随着PEEP的增加,平均EDR显著下降 (从-1.12 ± 1.05 到 -0.24 ± 0.20 cmH2O/μV,p < 0.01).
- 在EDR和PEEP水平之间观察到显著的相关性 (rs = 0.35,p < 0.01).
结论:
- 较高的PEEP通过调节呼吸系统的EDR,有效地限制了启发力.
- PEEP定位可能有助于控制自发通风冲击和降低P-SILI风险,从而可能实现更安全的ASB.
- 研究结果表明,PEEP可以将通风从高度自发到主要控制的模式转移,但需要临床验证.
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