根据电阻断层扫描预测急性呼吸困扰综合征患者的早期倾斜位置通风响应:一项前性研究
Yongran Wu1, Azhen Wang1, Chengchao Peng1
1Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
在急性呼吸困扰综合征 (ARDS) 中,在倾斜定位通风 (PPV) 之前,背部区域 (ROI 3) 的分离率预测了患者的反应. 这一发现有助于早期识别可能受益于PPV的患者.
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
- 医疗成像医学成像
背景情况:
- 超过20%的中度至重度ARDS患者通过倾斜定位通风 (PPV) 显示出有限的改善.
- 识别PPV反应的预测因素对于有针对性的干预和最大限度地减少不良影响至关重要.
- 需要对影响PPV疗效的可修改特征进行早期评估.
研究的目的:
- 使用电阻断层扫描 (EIT) 调查PPV的生理影响.
- 确定在早期阶段中度至重度ARDS患者中PPV反应的预测因素.
主要方法:
- 在94名中度至重度ARDS (PaO2/FiO2 <150 mmHg) 的成年患者中进行了前性观察性研究.
- 协议化PPV在输管后48小时内被施用.
- 在PPV之前和PPV后16小时收集了EIT数据和临床变量,分析了全球,区域和重力依赖的肺部区域.
主要成果:
- 83%的患者是PPV响应者,17%是非响应者.
- 在PPV前的响应者中观察到更高的呼吸系统符合性 (Crs) 和通风中心 (COV) 指数.
- 在ROI3 (背部区域) 中较高的分流百分比在PPV前独立预测PPV反应 (AUC0.89),截止值<8.4%显示高灵敏度 (94%) 和特异性 (76%). 在ROI3和Crs中结合顺位率,改善了预测 (AUC0.92).
结论:
- 在PPV之前由EIT测量的背部分流百分比 (ROI 3) 是PPV响应在中度至严重ARDS中显著的预测指标.
- 这一指标可以帮助早期识别可能受益于PPV的患者,允许及时进行治疗调整.
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