Department of Critical Care Medicine, Nanjing Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, People's Republic of China.
J Surg Res. 2013 Nov;185(1):347-52. doi: 10.1016/j.jss.2013.05.012. Epub 2013 May 25.
The heterogeneity of lung injury in pulmonary acute respiratory distress syndrome (ARDS) may have contributed to the greater response of hyperinflated area with positive end-expiratory pressure (PEEP). PEEP titrated by stress index can reduce the risk of alveolar hyperinflation in patients with pulmonary ARDS. The authors sought to investigate the effects of PEEP titrated by stress index on lung recruitment and protection after recruitment maneuver (RM) in pulmonary ARDS patients.
Thirty patients with pulmonary ARDS were enrolled. After RM, PEEP was randomly set according to stress index, oxygenation, static pulmonary compliance (Cst), or lower inflection point (LIP) + 2 cmH2O strategies. Recruitment volume, gas exchange, respiratory mechanics, and hemodynamic parameters were collected.
PEEP titrated by stress index (15.1 ± 1.8 cmH2O) was similar to the levels titrated by oxygenation (14.5 ± 2.9 cmH2O), higher than that titrated by Cst (11.3 ± 2.5 cmH2O) and LIP (12.9 ± 1.6 cmH2O) (P < 0.05). Compared with baseline, PaO2/FiO2 and recruitment volume were significantly improved after PEEP titration with the four strategies (P < 0.05). PaO2/FiO2 and recruitment volume were similar when using PEEP titrated by stress index and oxygenation but higher than that titrated by Cst and LIP. Compared with baseline, lung compliance increased significantly when PEEP determined by Cst, but there was no difference of Cst in these four strategies. There was no influence of PEEP titration with the four strategies on hemodynamic parameters.
PEEP titration by stress index might be more beneficial for pulmonary ARDS patients after RM.
急性呼吸窘迫综合征（ARDS）肺损伤的异质性可能导致呼气末正压（PEEP）治疗时过度充气区的反应更大。通过压力指数滴定 PEEP 可以降低 ARDS 患者肺泡过度充气的风险。作者旨在探讨在 ARDS 患者行肺复张（RM）后，通过压力指数滴定 PEEP 对肺复张后肺保护的影响。
共纳入 30 例 ARDS 患者。RM 后，根据压力指数、氧合、静态肺顺应性（Cst）或下拐点（LIP）+2cmH2O 策略随机设定 PEEP。收集患者的肺复张容积、气体交换、呼吸力学和血流动力学参数。
通过压力指数滴定的 PEEP（15.1±1.8cmH2O）与通过氧合滴定的 PEEP（14.5±2.9cmH2O）相似，高于通过 Cst 滴定的 PEEP（11.3±2.5cmH2O）和 LIP 滴定的 PEEP（12.9±1.6cmH2O）（P<0.05）。与基础值相比，四种策略的 PEEP 滴定后 PaO2/FiO2 和肺复张容积均显著改善（P<0.05）。通过压力指数和氧合滴定的 PEEP 时 PaO2/FiO2 和肺复张容积相似，但高于通过 Cst 和 LIP 滴定的 PEEP。与基础值相比，通过 Cst 确定的 PEEP 时肺顺应性显著增加，但这四种策略之间的肺顺应性没有差异。四种策略的 PEEP 滴定对血流动力学参数没有影响。
RM 后通过压力指数滴定 PEEP 可能对 ARDS 患者更有益。
