Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
Am J Respir Crit Care Med. 2012 Jan 1;185(1):24-33. doi: 10.1164/rccm.201104-0701OC.
Lateral airway pressure can provide valuable physiological information during bronchoscopy.
To evaluate tracheal obstruction during intervention.
To prospectively measure lateral airway pressure during bronchoscopy using a double-lumen catheter in 15 healthy subjects and 30 patients with tracheal obstruction. Pressure difference was used to evaluate the site of maximal obstruction. The angle between pressure recordings on either side of the stenosis was measured simultaneously (pressure-pressure curves) to assess the degree of tracheal obstruction.
In the experimental study, the angle of the pressure-pressure curve was unaffected by breathing maneuvers whereas the pressure difference was affected. In healthy subjects, no pressure difference between the carina and trachea was observed during tidal breathing, and the angle was close to 45°. In patients with tracheal obstruction, the dyspnea scale, pressure difference, and angle changed significantly beyond 50% obstruction (P<0.0001). After stenting, the pressure difference disappeared and the angle was close to 45°. The degree of tracheal obstruction was significantly correlated with the pressure difference (r=0.83, P<0.0001) and angle (r=-0.84, P<0.0001). The cross-sectional area, dyspnea scale, pulmonary function tests, pressure difference, and the angle significantly improved after procedures (P<0.0001). Responder rates on the modified Medical Research Council Scale were 84.6% for obstructions above 80%, and 58.8% for obstructions between 50 and 80%.
The direct measurement of pressure difference and the angle of the pressure-pressure curve represent a new assessment modality for the success of interventional bronchoscopy. Measuring lateral airway pressure could estimate the need for additional procedures better than bronchoscopy alone.
侧向气道压力在支气管镜检查期间可以提供有价值的生理信息。
评估介入期间的气管阻塞。
使用双腔导管前瞻性地测量 15 名健康受试者和 30 名气管阻塞患者支气管镜检查期间的侧向气道压力。使用压力差评估最大阻塞部位。同时测量狭窄两侧压力记录之间的角度（压力-压力曲线）以评估气管阻塞的程度。
在实验研究中，压力-压力曲线的角度不受呼吸动作的影响，而压力差则受影响。在健康受试者中，在潮式呼吸期间，隆嵴和气管之间没有观察到压力差，并且角度接近 45°。在气管阻塞患者中，呼吸困难量表、压力差和角度在阻塞超过 50%时显著变化（P<0.0001）。支架置入后，压力差消失，角度接近 45°。气管阻塞的程度与压力差（r=0.83，P<0.0001）和角度（r=-0.84，P<0.0001）显著相关。程序后气管阻塞的横截面积、呼吸困难量表、肺功能检查、压力差和角度均显著改善（P<0.0001）。改良的医疗研究委员会量表的应答率为阻塞>80%的为 84.6%，阻塞在 50%至 80%之间的为 58.8%。
直接测量压力差和压力-压力曲线的角度代表了一种新的介入支气管镜检查成功评估方式。测量侧向气道压力可以比单独进行支气管镜检查更好地估计是否需要额外的程序。
