在时间控制的适应性通风中,吸气压升高时间对肺空气的影响
Benjamin Neetz1,2,3, Patrick Rehn4,5,2, Nicole Kraus1,2
1Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg University Hospital, Germany.
Respiratory care
|August 25, 2025
概括
在时间控制的适应性通风 (TCAV) 中,将吸气压升高时间 (IPRT) 设置为0毫秒,可以改善肺空气和降低驾驶压力 (ΔP). 长时间的IPRT可能会误导内在PEEP (PEEPi) 的测量,并对通风产生负面影响.
科学领域:
- 机械通风
- 呼吸系统生理学
- 危急护理医学
背景情况:
- 气道压力释放通风 (APRV) 和时间控制的适应性通风 (TCAV) 的目的是尽量减少呼吸器引起的肺损伤 (VILI).
- 在TCAV中吸气压升高时间 (IPRT) 的作用尚不清楚.
- 不同的IPRT可能会影响肺部空气和关键呼吸系统参数.
研究的目的:
- 研究不同IPRT在TCAV期间对肺部空气和呼吸系统参数的影响.
- 评估IPRT是否影响驱动压力 (ΔP),内在PEEP (PEEPi) 和呼出的潮体积 (VTe).
- 在TCAV的不同IPRT下评估传统PEEPi测量的准确性.
主要方法:
- 一项前性探索性研究,涉及10名受试者接受了TCAV的输入管.
- 连续试验的IPRT为0毫秒 (基线),500毫秒和1000毫秒.
- 测量包括透气器衍生的 ΔP (ΔPvent),PEEPi,VTe,弹性 (ERS) 和通过电阻断断层扫描 (EIT) 测定的末尾肺体积 (EELV).
主要成果:
- 长时间的IPRT显著增加了弹性衍生的ΔP (ΔPelast) 与ΔPvent相比.
- 这种 ΔP 的增加与 PEEPi 的损失有关,这种损失没有通过传统测量检测到.
- 电阻断层扫描 (EIT) 显示了长时间IPRT的末尾呼吸肺体积 (EELV) 的减少.
结论:
- 在TCAV期间长时间的IPRT降低了EELV和PEEPi,因此增加了ΔP.
- 在这种情况下,传统的PEEPi测量方法不可靠.
- 建议将IPRT设置为0毫秒的TCAV协议以优化通风并可能减少VILI.
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