PEEP诱导的肺部招募机动与ARDS的倾斜姿势相结合:一个单中心,前性,随机临床试验
Lan Lan1,2, Yuenan Ni1,2, Yubei Zhou1,2
1Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China.
结合倾斜的姿势和积极的终端呼气压诱导的肺部招募机动,可以显著改善中度至重度ARDS患者的氧化和肺呼吸. 招聘与通货膨胀的比率有效地预测了患者对这些干预措施的反应.
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
- 肺部疾病 肺部疾病
背景情况:
- 倾斜定位 (PP) 和积极的末端呼气压力 (PEEP) 诱导的肺部招募机动 (LRM) 是已知的ARDS疗法.
- 在ARDS患者中,PP与PEEP诱导的LRM的联合疗效和协同效应需要进一步研究.
研究的目的:
- 评估将PP与PEEP诱导的LRM结合在一起对中度至重度ARDS的预后的影响.
- 评估肺部招募能力的预测值,特别是LRM响应的招募与通胀 (R/I) 比率.
主要方法:
- 在中度至重度ARDS患者中,前性研究比较PP与PP加上PEEP诱导的LRM.
- 监测了临床结果,呼吸机制和电阻断层扫描 (EIT).
- 在LRM期间测量了肺部可招募性 (R/I比),以预测治疗反应.
主要成果:
- 与单独使用PP相比,联合干预组显示氧化 (∆PaO2/FiO2: 75.8 mmHg) 和呼吸系统合规性 (∆Crs: 2 mL/cmH2O) 显著改善.
- 通过综合方法,EIT发现背部区域的通风分布增加 (5.0%对2.0%).
- 较高的R/I比率与LRM后更大的氧化改善相关 (r=0.4,p=0.034).
结论:
- 与PP相结合的PEEP诱导的LRM可增强中度至重度ARDS患者的氧化和背部通风.
- R/I比率是ARDS患者LRM反应的有价值预测指标.
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