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通过人体质量指数确定最佳的阳性末尾呼气压力不考虑肺压力的自然生理变化
Skyler Lentz1, Olivia Serigano1, William G Tharp2
1Department of Emergency Medicine, Division of Resuscitation Science, The Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, 05401, United States.
在机械通风中选择正极呼气压 (PEEP) 具有挑战性,因为身体质量指数 (BMI) 不同. "BMI / 3"方法近似平均最佳PEEP,但不考虑个体患者的变化.
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
- 麻醉学 麻醉学
背景情况:
- 机械通风需要精确的正极呼气压 (PEEP) 选择,这在各种体质指数 (BMI) 上是很困难的.
- 目前的方法如"BMI / 3"或肥胖的固定PEEP10cmH2O被提议,但缺乏对生理学措施的验证.
研究的目的:
- 为了比较"BMI/3"的准确性和10cmH2O的固定PEEP与通过食道测量测量确定的最佳PEEP.
- 为了评估人体测量PEEP估计方法在不同BMI的患者的疗效.
主要方法:
- 在109名接受腹腔镜手术的患者中使用食道计量仪来测量腹腔和肺周压力.
- 使用基于食道压力的透肺压力来确定最佳生理PEEP,与"BMI / 3"和10cmH2O的固定PEEP估计进行比较.
主要成果:
- 在37%的患者中",BMI/3"方法估计平均最佳PEEP在±2cmH2O范围内.
- 10cmH2O的固定PEEP仅在27%的患者中准确估计了最佳PEEP.
- 虽然"BMI / 3"接近平均最佳PEEP,但个人最佳PEEP范围在BMI类别之间有很大的差异.
结论:
- "BMI/3"公式可以作为高BMI患者PEEP设置的初始指南.
- 这种人体测量方法无法捕捉个体胸壁和胸腔压力变化,往往导致低于最佳的PEEP水平.
- 消化管计量仍然对于机械通风中精确,个性化的PEEP优化至关重要.
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