在接受各种机械呼吸模式的患者中,吸气后隔膜收缩
Antenor Rodrigues1,2,3, Fernando Vieira4,5, Michael C Sklar4,5
1Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada. antenor.rodrigues@unityhealth.to.
Critical care (London, England)
|September 18, 2024
概括
机械通风期间的吸气后隔膜收缩 (PIDC) 与特定的通风器设置有关. 像神经调节呼吸辅助 (NAVA) 这样的比例模式可以消除这些潜在的伤害性收缩.
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:
- 吸气后隔膜收缩 (PIDC) 是机械通风过程中的非生理事件.
- 在反向触发期间,PIDC可能会频繁出现,其中隔膜活动跟随呼吸器周期.
- 不同辅助通风模式中PIDC的发生程度尚不清楚.
研究的目的:
- 调查PIDCs和低血压呼吸衰竭患者的呼吸器设置之间的关联.
- 为了确定可能影响PIDC发生的患者特征.
- 为了在各种通风机模式中比较PIDC频率.
主要方法:
- 隔膜电肌图 (EAdi),气道压力和流量被记录了长达五天的时间.
- 呼吸被分为强制性,反向触发或患者触发的.
- 多变量逻辑回归分析了与PIDC相关的因素,包括EAdi参数,神经启发时间 (Ti neuro) 和呼吸器设置.
主要成果:
- 74%的逆触发呼吸,27%的压力支持和21%的辅助控制呼吸中发生了PIDC.
- PIDC与更高的EAdi峰值,更长的Ti neuro,更短的呼吸器吸气时间,高峰吸气流量和小的潮体积有关.
- 神经调整的呼吸辅助 (NAVA) 与没有PIDCs有关.
结论:
- 机械通风患者的PIDC和反向触发表型与可能可修改的因素有关,包括呼吸机设置.
- 像NAVA这样的比例模式有效地取消了PIDC.
- 了解这些关联可以为在通风过程中尽量减少隔膜损伤的策略提供信息.
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