在ARDS中PEEP对通风分布的影响
Bruno Louis1, Martin Cour2, Laurent Argaud2
1Institut Mondor de Recherches Biomédicales INSERM-UPEC U955 CNRS EMR7000, Créteil, France. bruno.louis@inserm.fr.
Respiratory care
|July 16, 2024
概括
电阻断层扫描 (EIT) 可以确定正极呼气压 (PEEP) 对ARDS患者肺呼吸分布的影响. 此外,EIT还准确估计了气道开口压力,有助于个性化PEEP设置.
科学领域:
- 肺部医学 肺部医学
- 关键护理医学 关键护理医学
- 生物医学工程 生物医学工程
背景情况:
- 机械通风对于患有中度至重度急性呼吸困扰综合征 (ARDS) 的患者至关重要.
- 积极的呼吸末端压力 (PEEP) 用于优化肺部招募并防止气囊缩.
- 优化PEEP是具有挑战性的,因为区域肺机械的变化.
研究的目的:
- 评估电阻断层扫描 (EIT) 以评估PEEP对区域通风分布的影响.
- 确定EIT识别崩,过度存在,低通风和悬浮风险的能力.
- 评估EIT的可行性,以估计气道开口压力 (AOP).
主要方法:
- 在9名ARDS患者的循环通风和缓慢吸气过程中记录了EIT信号.
- 区域通风分布和风险在5,10和15cmH2O的PEEP水平上进行了评估.
- 使用EIT估计了气道开口压力 (AOP),并与压力-体积曲线进行了比较.
主要成果:
- 较高的PEEP水平显著降低了肺体积的崩风险,并增加了风险过度存在的肺体积.
- 随着PEEP的增加,悬浮高度显著下降,这表明通风分布有所改善.
- 根据 EIT 的估计,AOP 与压力-体积曲线 (偏差为 0.48 cmH2O) 衍生的值有很好的一致性.
结论:
- 作为对ARDSPEEP调整的响应,EIT有效地监测区域通风变化.
- 伊特提供了一种可行的AOP估计方法,补充了传统的测量方法.
- EIT可以帮助临床医生为ARDS患者制定个性化的PEEP设置.
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