在新生儿和儿科ARDS中区域通风分布的EIT指导评估:一个前性可行性研究
Leon Soltész1, Judith Leyens1,2, Marieke Vogel3
1Department of Neonatology and Pediatric Intensive Care, University Children´s Hospital Bonn, Bonn, Germany.
Respiratory research
|February 19, 2025
概括
电阻断层扫描 (EIT) 是一种可行的床边工具,用于优化新生儿和儿科急性呼吸困扰综合征 (nARDS/pARDS) 的阳性末尾呼吸压力 (PEEP). 这种个性化策略可以改善通风分配,减少呼吸器引起的肺损伤 (VILI).
科学领域:
- 临界护理医学 临界护理医学
- 儿科肺病学 儿科肺病学
- 生物医学工程 生物医学工程
背景情况:
- 关于新生儿/儿科急性呼吸窘迫综合征 (nARDS/pARDS) 中区域通风和肺机械的床边监测,存在有限的前性数据.
- 电阻断层扫描 (EIT) 是一种无辐射的床边工具,用于分析区域通风分布.
- 之前的成人试验表明,以EIT为指导的策略可以改善结果并减少呼吸器诱导的肺损伤 (VILI).
研究的目的:
- 评估使用EIT在患有ARDS的儿科和新生儿患者中进行个性化正极呼吸压力 (PEEP) 定位的可行性和安全性.
- 评估以EIT为指导的PEEP战略在优化区域通风分布方面的有效性.
- 探索EIT衍生参数与肺机械学之间的相关性.
主要方法:
- 一个单一中心的前性可行性研究,涉及26名新生儿和儿科患者,他们被诊断患有nARDS/围产期肺病 (PLD) 或pARDS.
- 在递减PEEP试验期间持续监测EIT以确定基于像素合规的EIT引导PEEP (EIT-PEEP) (CEIT).
- 对EIT衍生指数的离线分析,包括全球不均质指数 (GI) 和通风中心 (CoV).
主要成果:
- 进行了40次EIT测量,其中13名患者被归类为严重的nARDS/pARDS.
- 中位数EIT-PEEP (11 mbar) 显著低于临床规定的PEEP (11.5 mbar) 和ARDS网络PEEP建议 (14 mbar).
- 在EIT-PEEP和动态合规性 (CDYN) 之间发现了显著的相关性,R2=0.265 (p=0.005).
结论:
- 对于nARDS/PLD和pARDS患者,包括那些体外膜氧化 (ECMO) 患者,EIT是一种可行的和安全的监测工具.
- 以EIT合规为指导的个性化PEEP策略可以优化区域通风分配.
- 这种方法有可能减少重症新生儿和儿童的VILI.
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