胸部手术中的开放肺呼吸和机械动力:多中心随机试验的后期分析
Andres Zorrilla-Vaca1, Enric Barbeta, Julian Librero
1From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA (AZV), Department of Anesthesiology, Hospital Universitario Evaristo Garcia, Universidad del Valle, Cali, Colombia (AZV), Department of Anesthesiology and Critical Care, Hospital Clinic de Barcelona, Barcelona (EB, CF), Red de Investigacion en Servicios de Salud, Navarrabiomed, Complejo Hospitalario de Navarra, Pamplona, Spain (JL), Institut D'investigacio August Pi I Sunyer, Barcelona (CF) and CIBER de Enfermedades Respiratorias CIBERES, Instituto de Salud Carlos III, Madrid, Spain (CF).
在胸部手术中,在单肺通风 (OLV) 过程中个性化正端呼气压力 (PEEP) 稍微增加机械功率,但不会显著影响术后并发症. 机械功率的不同组成部分与患者的结果有不同的关联.
科学领域:
- 麻醉学
- 危急护理医学
- 呼吸系统生理学
背景情况:
- 个性化正端呼气压力 (PEEP) 在通风过程中优化呼吸机制.
- 机械功率是肺部损伤的一个已知的危险因素.
- 在单肺通风 (OLV) 过程中,PEEP优化与机械功率之间的关系尚不清楚.
研究的目的:
- 研究个性化PEEP在OLV期间对机械功率的影响.
- 确定胸部手术后机械功率与术后肺部并发症 (PPC) 的相关性.
主要方法:
- 一个多中心随机试验的后期分析,涉及1253名接受OLV胸部手术的患者.
- 五个时间点的开放式通风策略 (个性化PEEP) 和标准PEEP之间的机械功率及其组件的比较.
- 多变量混合效应后勤回归以评估机械功率值与PPC之间的关联.
主要成果:
- 与标准PEEP相比,开放肺通风在OLV期间产生更高的中间机械功率 (例如,在OLV结束时增加2.12 J/min).
- 机械功率的电阻成分与PPC增加有关 (OR为1.07每J/分钟).
- 机械功率的静态成分显示出对PPC的保护作用 (OR 0.91每J/分钟).
结论:
- 与标准PEEP相比,在OLV期间个性化PEEP导致机械功率的非临床显著增加.
- 机械功率的不同组成部分与术后肺部并发症的发生有着不同的关系.
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