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在侵袭性通风儿童中使用体积测量方法估计肺间驱动压力,应变和肺特异弹性-可行性研究

Farhan A Rashid Shaikh¹, Nandan Kalkunte Venugopal¹, Monesh Kethineni Bhaskaran¹

¹Department of Pediatric Intensive Care, Rainbow Children's Hospital, Banjara Hills, Hyderabad, Telangana, India.

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

|February 16, 2026

概括

整合积极的终端呼气压力步骤 (PEEP步骤) 和多重呼吸洗进/洗出 (NMBW) 方法可能允许估计跨肺驱动压力,应变和儿童的肺弹性. 需要进一步验证.

科学领域:

儿科重症监护生理学儿科重症监护生理学
呼吸系统力学研究研究
机械通风技术机械通风技术

背景情况:

估计机械通风儿童的肺部机制对于优化护理至关重要.
目前用于评估驱动压力和肺弹性等参数的方法存在局限性.
多重呼吸洗进/洗出 (NMBW) 和正极呼吸压力步骤 (PEEP-step) 方法为非侵入性评估提供了潜力.

研究的目的:

评估将NMBW技术与PEEP步骤方法相结合的可行性.
确定这种综合方法是否可以准确地估计儿科患者的肺横驱动压力 (DPTP),应变和肺特异弹性 (k).
探索功能剩余容量 (FRC) 和呼吸合规性之间的关系.

主要方法:

在儿科重症监护室 (PICU) 进行了一项前性可行性研究.
被入侵通风的2个月至16岁的儿童被录取.
功能剩余容量 (FRC) 用NMBW在零终端呼气压 (ZEEP) 测量,并在PEEP步骤中测量了终端呼气肺体积.

主要成果:

分析了33名儿童的数据,其中18名患有儿科急性呼吸困扰综合征 (PARDS).
在ZEEP的FRC和呼吸合规性之间观察到显著的相关性 (rho = 0.775; p < 0.001).
菌株与DPTP (rho = 0.55; p < 0.001) 和平原压力 (rho = 0.72; p < 0.001) 有正相关性. 在PARDS患者中,肺特异性弹性 (k) 的中位数较低,但这种差异在正常化后消失了.

结论:

整合PEEP-step和NMBW方法似乎可行,用于估计儿科患者的DPTP,菌株和k,尽管存在技术挑战.
这些发现表明,一种潜在的非侵入性方法可以监测肺部机制.
建议对食道压力计进行验证,这是黄金标准,用于未来的研究.

关键词:

肺部特定的弹性弹性.多次呼吸洗进/洗出洗进/洗出压力压力压力压力压力就是压力,压力就是压力.跨肺动力压力驱动器呼吸机引起的肺损伤

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