Ruiz Ferrón F, Serrano Simón J M
Unidad de Cuidados Intensivos, Hospital Universitario San Cecilio, Granada, España.
Unidad de Cuidados Intensivos, Hospital Reina Sofía, Córdoba, España.
Med Intensiva (Engl Ed). 2019 May;43(4):197-206. doi: 10.1016/j.medin.2018.02.015. Epub 2018 Apr 1.
Study the relationship and concordance between calculated respiratory effort using the signals of the ventilator (Pmus) and that measured in esophageal pressure (Pes) on mechanical ventilation with different levels of respiratory assistance.
Prospective cohort study.
Intensive Care Unit of 2 universitary hospitals. Patients Patients on weaning time.
Airway, esophageal and respiratory flow were recorded on CPAP, assist volume control (ACV) and pressure support (PS), with complete (ACV1,PS1) and partial assistance (ACV5,PS5).
respiratory variations of Pes and Pmus (Δ: cmHO) and pressure time product (PTPm: cmHO·s/m).
Fourty one records were studied, the assistance was in CPAP of 5cmH2O, PS1 of 15±5 reduced to 9±4cmHO. In ACV1 the inspiratory flow was 1±0.2l/s, reduced to 0.49±0.1l/s for ACV5. The increase in respiratory assistance decreases respiratory effort, measured in Delta Pes (CPAP, ACV5, ACV1, PS5, PS1): 11±3, 6±3, 5±3, 9±6, 7±7 and in Pmus 16±5, 10±6, 5±3, 10±6, 5±4cmHO (P<.001). The PTP per minute measured in Pes: 213±87, 96±91, 23±24, 206±121, 108±100 (P=.001) and in Pmus: 293±117, 156±84, 24±32, 233±121, 79±90 (P<.001). The measurements in Pes and Pmus showed the following correlation, in Delta: 0.72 and PTPm, 0.87. The Bland-Altman analysis indicates that the difference between Delta Pes-Pmus can be 16 and the PTPm of 264 and the systematic error in Delta: -0.98±4.4 and PTPm -23.69±66.3cmHO·s/m.
Calculated and measured parameters of respiratory effort showed unacceptable differences in clinical practice.
研究在不同呼吸辅助水平的机械通气中，利用呼吸机信号计算的呼吸功（Pmus）与食管压力测量值（Pes）之间的关系及一致性。
前瞻性队列研究。
2所大学医院的重症监护病房。处于撤机阶段的患者。
在持续气道正压通气（CPAP）、辅助容量控制（ACV）和压力支持（PS）模式下，记录气道、食管和呼吸流量，包括完全辅助（ACV1、PS1）和部分辅助（ACV5、PS5）情况。
Pes和Pmus的呼吸变化（Δ：cmH₂O）以及压力时间乘积（PTPm：cmH₂O·s/m）。
共研究了41份记录，辅助情况为CPAP 5cmH₂O，PS1从15±5cmH₂O降至9±4cmH₂O。在ACV1中吸气流量为1±0.2l/s，ACV5时降至0.49±0.1l/s。呼吸辅助增加会降低呼吸功，以ΔPes衡量（CPAP、ACV5、ACV1、PS5、PS1）：分别为11±3、6±3、5±3、9±6、7±7cmH₂O，以Pmus衡量分别为16±5、10±6、5±3、10±6、5±4cmH₂O（P<0.001）。每分钟在Pes中测量的PTP：213±87、96±91、23±24、206±121、108±100cmH₂O·s/m（P = 0.001），在Pmus中测量的PTP：293±117、156±84、24±32、233±121、79±90cmH₂O·s/m（P<0.001）。Pes和Pmus的测量值在Δ方面相关性为0.72，在PTPm方面相关性为0.87。Bland - Altman分析表明，ΔPes - Pmus之间的差异可达16cmH₂O，PTPm差异可达264cmH₂O·s/m，Δ的系统误差为 - 0.98±4.4cmH₂O，PTPm的系统误差为 - 23.69±66.3cmH₂O·s/m。
在临床实践中，计算和测量的呼吸功参数显示出不可接受的差异。
