Verscheure Sara, Massion Paul B, Verschuren Franck, Damas Pierre, Magder Sheldon
Department of Critical Care Medicine, University of McGill, Montreal, Quebec, Canada.
Department of General Intensive Care, University Hospital of Liege, Liege, Belgium.
Crit Care. 2016 Jun 23;20(1):184. doi: 10.1186/s13054-016-1377-3.
Dead space is an important component of ventilation-perfusion abnormalities. Measurement of dead space has diagnostic, prognostic and therapeutic applications. In the intensive care unit (ICU) dead space measurement can be used to guide therapy for patients with acute respiratory distress syndrome (ARDS); in the emergency department it can guide thrombolytic therapy for pulmonary embolism; in peri-operative patients it can indicate the success of recruitment maneuvers. A newly available technique called volumetric capnography (Vcap) allows measurement of physiological and alveolar dead space on a regular basis at the bedside. We discuss the components of dead space, explain important differences between the Bohr and Enghoff approaches, discuss the clinical significance of arterial to end-tidal CO2 gradient and finally summarize potential clinical indications for Vcap measurements in the emergency room, operating room and ICU.
死腔是通气-灌注异常的一个重要组成部分。死腔测量具有诊断、预后评估和治疗应用价值。在重症监护病房（ICU），死腔测量可用于指导急性呼吸窘迫综合征（ARDS）患者的治疗；在急诊科，它可指导肺栓塞的溶栓治疗；在围手术期患者中，它可表明肺复张手法的成功与否。一种新出现的技术——容积式二氧化碳描记法（Vcap），能够在床边定期测量生理死腔和肺泡死腔。我们讨论了死腔的组成部分，解释了玻尔（Bohr）法和恩霍夫（Enghoff）法之间的重要差异，讨论了动脉血与呼气末二氧化碳分压差的临床意义，最后总结了在急诊室、手术室和ICU中进行Vcap测量的潜在临床适应证。
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