在楼梯高频振荡式通风招募机动期间的肺部行为
Pauline de Jager1, Alette A Koopman2, Dick G Markhorst3
1Division of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Internal Post Code CA 80, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. p.de.jager@umcg.nl.
Intensive care medicine experimental
|April 25, 2024
概括
在高频振荡通风 (HFOV) 期间的肺体积优化机动 (LVOM) 显示出显著的肺体积变化和异质性. 调整HFOV压力和时间对于患者稳定至关重要.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 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机
背景情况:
- 肺体积优化机动 (LVOM) 是有效的高频振荡通风 (HFOV) 的必要条件.
- 对于儿科患者在LVOM期间的肺行为,体积变化和招募动态的了解有限.
- 量化招聘和退聘,以及稳定时间,对于优化HFOV设置至关重要.
研究的目的:
- 分析HFOV.在儿科患者的LVOM期间的肺体积变化.
- 在LVOM期间量化肺部招募和退役.
- 为了确定压力变化后肺体积稳定时间.
主要方法:
- 对从小儿科受试者 (<18岁) 收集的关于HFOV的前性数据的二次分析.
- 呼吸诱导囊造影 (RIP) 用于测量在LVOM膨胀和通缩期间的肺部招募和退役.
- 使用尼曼模型计算时间常数,以评估肺体积稳定.
主要成果:
- 分析包括51名患有中度至重度儿科急性呼吸困扰综合征 (PARDS) 的儿科患者.
- 在LVOM通胀和通缩阶段,即使在高通胀压力下,也观察到肺部招聘和退聘.
- 稳定的肺体积 (时间常数) 的时间只能在通胀的26.2%和通缩压变化的21.4%中计算出来,独立于连续膨胀压力 (CDP).
结论:
- 在楼梯增量-下降LVOM期间肺行为的显著异质性被确定.
- 在从传统的机械通风 (CMV) 过渡到HFOV时,建议使用更高的初始通风压.
- 压力变化之间需要长时间的间隔,以便在LVOM期间实现肺平衡.
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