倾斜的位置减少了ARDS患者的呼吸道关闭,患者正在经历毒性体外膜氧化
Marco Giani1,2, Andrea Restivo1, Davide Raimondi Cominesi1
1School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Journal of clinical monitoring and computing
|July 27, 2024
概括
在静脉静脉外体膜氧化 (VV ECMO) 严重急性呼吸困扰综合征 (ARDS) 的患者中,倾斜的位置显著减少了气道关闭. 这种机动改进了机械通风期间的呼吸力学评估.
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
- 机械通风机械通风机械通风
背景情况:
- 机械通风期间的气道关闭可能导致不准确的驾驶压力测量和PEEP设置.
- 严重急性呼吸困扰综合征 (ARDS) 患者可能会出现气道闭塞,可通过低流膨胀检测到.
- 卧床是ARDS死亡率的关键干预措施,但其对气道关闭的影响尚不清楚.
研究的目的:
- 在VV ECMO支持的ARDS患者中,研究倾斜定位对气道关闭的影响.
- 评估躺卧前后气道压力波形的变化.
主要方法:
- 在体积控制通风和低流量膨胀过程中分析压力波形.
- 在VV ECMO治疗的ARDS患者中,在仰卧和倾斜的位置进行了评估.
主要成果:
- 高气道打开压力 (23cmH2O) 表明气道关闭,在卧卧姿势下观察到.
- 倾斜的位置降低了通气道的开口压力到13cmH2O,减弱了通气道的关闭.
- 气道关闭仍然减少 (17cmH2O) 即使在返回卧卧姿势后.
结论:
- 倾斜的位置有效地减少了在VV ECMO上的ARDS患者的气道关闭.
- 这一发现表明,倾斜的位置可能会提高这些重症患者呼吸机制评估的准确性.
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