在ARDS的部分支通风过程中,加上呼吸叠加的双循环:只是自然变化的特征吗?
Roberto Brito1, Caio C A Morais2,3, Daniel H Arellano1,4
1Departamento de Medicina, Hospital Clínico Universidad de Chile, Unidad de Pacientes Críticos, Dr. Carlos Lorca Tobar 999, Independencia, Santiago, Chile.
Critical care (London, England)
|January 10, 2025
概括
在机械通风期间,与呼吸堆叠 (DC/BS) 进行双循环是不常见的,并且与呼吸变化有关. 这些事件类似于自发的叹息,在部分呼吸器支持期间可能不会有害.
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:
- 双循环与呼吸堆叠 (DC/BS) 经常被视为机械通风期间高呼吸驱动和潜在的肺损伤的迹象.
- 然而,在部分呼吸器支持期间,DC/BS可能反映了生理呼吸模式的变化,而不是固有的风险.
研究的目的:
- 评估接受部分呼吸器支持的低血症患者中DC/BS事件的发生和生理影响.
- 为了比较不同通风模式的DC/BS发生率:神经调节的通风辅助 (NAVA),比例辅助通风 (PAV+) 和压力支持通风 (PSV).
主要方法:
- 一项涉及低血量患者的交叉研究的二次分析.
- DC/BS事件被定义为两个连续的吸入周期与不完整的呼气.
- 测量包括呼吸机制 (例如,动态遵守,呼吸末端肺阻抗) 和患者的努力.
主要成果:
- 在所有模式中,DC/BS事件的发生频率不高,在PAV+中发生率最低.
- 潮体积和呼吸速率的更高变化与DC/BS的增加有关.
- DC/BS呼吸显示潮体积增加和肺部伸展,其次是改善肺部服从性和末尾呼气肺阻抗.
结论:
- 在部分呼吸器支期间发生的DC/BS事件并不常见,并且与呼吸变化有关.
- DC/BS的生理效应类似于自发的叹息,并且似乎并非本质上有害.
- 这些发现表明,在这种情况下,不应该假定DC/BS是有害的.
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