在气道关闭的情况下,食道压力的校准错误
Mattia Docci1,2, Francois Beloncle3, Arnaud Lesimple3,4
1Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
Critical care (London, England)
|May 2, 2025
概括
机械通风期间的气道关闭可能会损害食道压力测量. 在吸入结束时进行闭塞测试可以提高食道气球校准的准确性,特别是在呼吸道关闭的患者中.
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
背景情况:
- 在机械通风过程中,气道关闭会阻碍近道和远道气道之间的通讯.
- 消化管压力 (Pes) 监测对于在ARDS,肥胖和肺等疾病中个性化机械通风至关重要.
- 精确的食道气球校准对于可靠的Pes测量至关重要.
研究的目的:
- 为了研究气道关闭对食道气球校准的影响,在正压阻塞试验中使用∆Paw/∆Pes比率.
- 为了确定执行闭塞测试的最佳时间,以确保准确的校准.
主要方法:
- 这项研究使用了12具人类尸体,在呼气结束和吸气结束时诱导气道关闭.
- 校准测试在不同水平的正极呼气压 (PEEP) 进行.
- 在需要Pes监测的两名患者中,观察结果得到了证实.
主要成果:
- ∆Paw/∆Pes的显著差异观察到,当总PEEP低于气道开口压力 (AOP) 在终止呼气和终止吸气时 (0.42对0.95,P<0.001).
- 当总PEEP高于AOP (0.99比0.99,P=0.854) 时,没有发现显著差异.
- 气道封闭导致低估∆Paw/∆Pes,并且当测试在AOP以下时可靠性降低.
结论:
- 胸部压缩在气道关闭期间不会完全传输到气道,这会影响校准.
- 在末端吸入性阻塞期间建议进行正压阻塞试验,作为食道气球校准的标准程序.
- 这种方法提高了潜在气道关闭的患者Pes监测的可靠性.
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