流量控制通风与压力控制通风在中度至重度ARDS患者:一个随机交叉生理学研究
Julien P van Oosten1, Juliette E Francovich2, Dolf Weller2,3
1Intensive Care, Erasmus Medical Center, Intensive Care Volwassenen, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. j.vanoosten@erasmusmc.nl.
在ARDS患者中,流量控制通风 (FCV) 与压力控制通风 (PCV) 相比,没有显著降低机械功率 (MP). FCV显示出肺部过度张张的趋势,引发了安全问题.
科学领域:
- 临界护理医学 临界护理医学
- 呼吸系统生理学 呼吸系统生理学
- 机械通风机械通风机械通风
背景情况:
- 在机械通风急性呼吸窘迫综合征 (ARDS) 患者中,预防呼吸器诱导的肺损伤 (VILI) 是至关重要的.
- 高机械功率 (MP) 与VILI相关.
- 控制流量通风 (FCV) 正在探索潜在的减少VILI和atelectrauma.
研究的目的:
- 为了比较FCV和压力控制通风 (PCV) 之间的MP.
- 用电阻断层扫描 (EIT) 评估FCV对通风分布和均性的影响.
主要方法:
- 一项随机交叉试点研究,涉及10名中度至重度ARDS的ICU患者.
- 患者接受了90分钟的FCV,然后90分钟的PCV,反之亦然.
- 持续监测压力,流量,EIT和重复的血液气体分析;MP是从压力-体积循环计算的.
主要成果:
- 优化的FCV和PCV产生了类似的MP (12.6对14.8 J/min).
- FCV改善了通风分布,但显示出过度膨胀的趋势,特别是在非依赖性肺部区域.
- 研究由于安全问题而提前停止,包括过度膨胀和高头.
结论:
- 在ARDS患者中,优化FCV导致相似的MP与PCV相比.
- FCV显示出肺部过度张张的趋势,表明潜在的安全风险.
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