在急性呼吸衰竭患者的腹内压力基础上优化积极的呼吸末端压力
P Hancı1, E T Demir2, B Şekerci3
1Department of Pulmonology Medicine, Division of Intensive Care, Trakya University Faculty of Medicine, Edirne, Türkiye.
Nigerian journal of clinical practice
|August 30, 2024
概括
在机械通风患者中,根据腹内压力 (IAP) 调整正极端呼气压 (PEEP) 显著改善了氧化. 这种方法在资源有限的环境中特别有用,因为缺乏先进的PEEP定位技术.
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
- 机械通风机械通风机械通风
背景情况:
- 阳性末尾呼气压 (PEEP) 对于呼吸衰竭的重症患者的氧化至关重要.
- 腹腔内高血压可以影响胸部压力,可能导致肺损伤 (atelectotrauma) 与不充分的PEEP.
- 了解PEEP-IAP的相互作用对于优化通风策略至关重要.
研究的目的:
- 为了评估由腹内压力 (IAP) 引导的PEEP定位对氧化的影响.
- 评估与此PEEP调整策略相关的任何潜在不良影响.
- 为了提供证据,在低血压呼吸衰竭中提供另一种PEEP管理方法.
主要方法:
- 包括患有缺血性呼吸衰竭需要机械通风和正常IAP (<15 mmHg) 的成年患者.
- 严重心血管功能障碍的患者被排除在外.
- 应用了三个PEEP水平:PEEPzero (0cmH2O),PEEPIAP/2 (50%的IAP) 和PEEPIAP (100%的IAP),测量时间隔30分钟.
主要成果:
- 随着PEEP的增加,观察到PaO2/FiO2比率 (P < 0.001) 和平原压力 (P < 0.001) 的总体显著增加.
- 双对对比显示,所有测试PEEP水平之间的PaO2/FiO2显著改善 (P < 0.001).
- 在所有PEEP设置中,平原压力保持在安全范围内 (<30cmH2O).
结论:
- 基于IAP的PEEP调整有效地提高了机械通风患者急性低血压呼吸衰竭的氧化.
- 这种由IAP指导的PEEP策略在资源有限的环境中提供了一个实际的解决方案,在这种环境中,其他定位方法是不可用的.
- 该方法证明了在平原压力保持在临界值以下的情况下的安全性.
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