Markhorst Dick G, Jansen Jos R C, van Vught Adrianus J, van Genderingen Huibert R
Pediatric ICU, Department of Pediatrics, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands.
Intensive Care Med. 2005 Mar;31(3):424-30. doi: 10.1007/s00134-004-2535-7. Epub 2005 Jan 20.
To assess the value of monitoring abdominal and rib cage tidal displacement as an indicator of optimal mean airway pressure (Paw) during high-frequency oscillatory ventilation (HFOV).
Prospective observational study in a university research laboratory.
Eight piglets weighing 12.0+/-0.5 kg, surfactant depleted by lung lavage.
Compliance of the respiratory system (C(rs)) was calculated from a quasistatic pressure volume loop. After initiation of HFOV lung volume was recruited by increasing Paw to 40 cmH(2)O. Then mean Paw was decreased in steps until PaO(2)/FIO(2) was below 100 mmHg. Proximal pressure amplitude remained constant.
Abdominal and rib cage tidal displacement was determined using respiratory inductive plethysmography. During HFOV there was maximum in tidal volume (Vt) in seven of eight piglets. At maximal mean Paw abdominal and rib cage displacement were in phase. Phase difference between abdominal and rib cage displacement increased to a maximum of 178+/-28 degrees at minimum mean Paw. A minimum in abdominal displacement and a maximum of Vt was found near the optimal mean Paw, defined as the lowest mean Paw where shunt fraction is below 0.1.
During HFOV abdominal and rib cage displacement displayed mean Paw dependent asynchrony. Maximal Vt and minimal abdominal displacement coincided with optimal C(rs), oxygenation, and ventilation, suggesting potential clinical relevance of monitoring Vt and abdominal displacement during HFOV.
评估监测腹部和胸廓潮气量位移作为高频振荡通气（HFOV）期间最佳平均气道压力（Paw）指标的价值。
在大学研究实验室进行的前瞻性观察性研究。
8只体重12.0±0.5千克的仔猪，通过肺灌洗使其表面活性物质减少。
根据准静态压力-容积环计算呼吸系统顺应性（C(rs)）。开始高频振荡通气后，通过将Paw增加到40 cmH₂O来募集肺容积。然后逐步降低平均Paw，直到动脉血氧分压/吸入氧分数（PaO₂/FIO₂）低于100 mmHg。近端压力振幅保持恒定。
使用呼吸感应体积描记法测定腹部和胸廓潮气量位移。在高频振荡通气期间，8只仔猪中有7只的潮气量（Vt）达到最大值。在最大平均Paw时，腹部和胸廓位移同步。在最小平均Paw时，腹部和胸廓位移之间的相位差增加到最大178±28度。在定义为分流分数低于0.1的最低平均Paw附近，发现腹部位移最小且Vt最大。
在高频振荡通气期间，腹部和胸廓位移显示出与平均Paw相关的不同步性。最大Vt和最小腹部位移与最佳C(rs)、氧合和通气一致，表明在高频振荡通气期间监测Vt和腹部位移具有潜在的临床意义。
