Dhand Rajiv
Division of Pulmonary, Critical Care, and Environmental Medicine, Department of Internal Medicine,University of Missouri-Columbia, Columbia, MO 65212, USA.
Respir Care. 2005 Feb;50(2):246-61; discussion 259-61.
Obstruction of the large and small airways occurs in several diseases, including asthma, chronic obstructive pulmonary disease, cystic fibrosis, bronchiectasis, and bronchiolitis. This article discusses the role of ventilator waveforms in the context of factors that contribute to the development of respiratory failure and acute respiratory distress in patients with obstructive lung disease. Displays of pressure, flow, and volume, flow-volume loops, and pressure-volume loops are available on most modern ventilators. In mechanically ventilated patients with airway obstruction, ventilator graphics aid in recognizing abnormalities in function, in optimizing ventilator settings to promote patient-ventilator interaction, and in diagnosing complications before overt clinical signs develop. Ventilator waveforms are employed to detect the presence of dynamic hyperinflation and to measure lung mechanics. Various forms of patient-ventilator asynchrony (eg, auto-triggering and delayed or ineffective triggering) can also be detected by waveform analysis. Presence of flow limitation during expiration and excessive airway secretions can be determined from flow-volume loops. Abnormalities in pressure-volume loops occur when the trigger sensitivity is inadequate, with alterations in respiratory compliance, or during patient-ventilator asynchrony. Thus, ventilator waveforms play an important role in management of mechanically-ventilated patients with obstructive lung disease.
大小气道阻塞见于多种疾病,包括哮喘、慢性阻塞性肺疾病、囊性纤维化、支气管扩张症和细支气管炎。本文在导致阻塞性肺疾病患者呼吸衰竭和急性呼吸窘迫发生的因素背景下,探讨通气波形的作用。大多数现代呼吸机都能显示压力、流量和容积、流量-容积环以及压力-容积环。在机械通气的气道阻塞患者中,通气机图形有助于识别功能异常、优化通气机设置以促进患者-通气机相互作用,以及在明显临床体征出现之前诊断并发症。通气波形用于检测动态肺过度充气的存在并测量肺力学。波形分析还可检测各种形式的患者-通气机不同步(如自动触发以及延迟触发或无效触发)。呼气时流量受限和气道分泌物过多可通过流量-容积环确定。当触发灵敏度不足、呼吸顺应性改变或患者-通气机不同步时,压力-容积环会出现异常。因此,通气波形在机械通气的阻塞性肺疾病患者的管理中发挥着重要作用。