在单肺通风过程中通过肺部合规性进行个性化PEEP定位:元分析
Wan-Jie Gu1, Feng-Zhi Zhao1, Federico Piccioni2
1Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Critical care (London, England)
|January 17, 2025
概括
在单肺通风 (OLV) 过程中,通过肺部合规度进行个性化正极端呼气压 (PEEP) 定位,可以减少术后的肺部并发症. 这种方法改善了呼吸机制和氧化,提供了比固定PEEP更安全的方法.
科学领域:
- 麻醉学和重症监护医学
- 呼吸系统生理学 呼吸系统生理学
- 基于证据的医学 基于证据的医学
背景情况:
- 阳性终端呼气压 (PEEP) 提供了生理上的好处,但其在单肺通风 (OLV) 期间的最佳使用尚未确定.
- 调查基于肺部顺应的个性化PEEP定位对于优化OLV期间患者的治疗结果至关重要.
研究的目的:
- 为了确定通过肺部合规来个性化PEEP标化是否可以减少OLV患者手术后肺部并发症.
- 为了比较个性化PEEP定位与固定PEEP策略的疗效.
主要方法:
- 从PubMed,Embase和Cochrane图书馆获取到2024年4月的随机对照试验 (RCT) 的系统审查和元分析.
- 包括RCT在OLV期间与固定PEEP进行了对比,通过肺部符合性对个性化PEEP标位进行了比较.
- 主要结局:术后肺部并发症的组合. 二次结果:临床事件,呼吸机制,气体交换和血液动力学.
主要成果:
- 与3426名患者进行的十项RCT表明,个性化PEEP定位显著降低了复合术后肺部并发症的风险 (RR 0.55;95%CI 0.38-0.78).
- 这种好处在动态合规和逐步下降的PEEP定位策略中更为明显.
- 个性化PEEP改善了动态合规性,氧化 (PaO2,PaO2/FiO2) 和降低了驾驶压力,死亡率或心血管并发症没有显著差异.
结论:
- 根据肺部的符合性进行个性化PEEP标配,在减少OLV期间术后肺部并发症方面优于固定PEEP.
- 该策略在使用动态合规或逐步递减方法时特别有效.
- 这种个性化的方法可以增强呼吸机制和氧化,而不会产生不良的血液动力学影响.
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