使用逐步的肺部招募机动来预测在手术室的肺部防护通风下流体的响应能力
Eun Hee Chun1, Mi Hwa Chung1, Jung Eun Kim1
1Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
渐进的肺部招募机动 (LRM) 有效地预测肺部保护性通风 (LPV) 患者的液体反应. 在LRM过程中增加的脉冲压力变化 (PPV) 和脉冲体积变化 (SVV) 是指导流体治疗的可靠指标.
科学领域:
- 临界护理医学 临界护理医学
- 呼吸系统生理学 呼吸系统生理学
- 血液动力学 血液动力学
背景情况:
- 在机械通风患者中,液体反应的预测至关重要.
- 肺部招募机动 (LRM) 可以诱导血液动力学变化.
- 肺部保护性通风 (LPV) 是标准的护理,但流体管理仍然具有挑战性.
研究的目的:
- 评估逐步LRM在预测流体响应性的有效性.
- 评估在LRM期间增强脉冲压力变化 (PPV) 和冲击体积变化 (SVV) 的实用性.
- 为了确定PPV和SVV在预测流体响应器中的最佳切断值.
主要方法:
- 研究了41名在LPV治疗中患有"灰色区域"PPV (4-17%) 的患者.
- 进行逐步的LRM,增加PEEP和持续的驱动压力.
- 使用FloTrac-Vigileo和患者监视器测量了中风体积变化 (SVV) 和PPV.
- 流体响应被定义为在流体挑战后,中风体积 (SV) 增加≥15%.
主要成果:
- 逐步LRM生成的增强PPV和SVV预测了流体响应.
- 增强PPV的曲线下的面积为0.76;对于SVV,它是0.78.
- 预测流体反应者的最佳切断点是PPV>18%和SVV>13%.
- 在41名患者中,有17人被确定为流体反应者.
结论:
- 逐步LRM是预测LPV患者的液体反应能力的宝贵工具.
- 在LRM期间增强的PPV和SVV可以指导流体治疗决策.
- 这种方法有助于优化重症患者的流体管理.
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