平均容量保证压力支持模式下潮气量的可靠性

Reliability of Tidal Volume in Average Volume Assured Pressure Support Mode.

作者信息

Stagnara André, Baboi Loredana, Nesme Pascale, Subtil Fabien, Louis Bruno, Guérin Claude

机构信息

Service de Pneumologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.

Service de Réanimation médicale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.

出版信息

Respir Care. 2018 Sep;63(9):1139-1146. doi: 10.4187/respcare.05917. Epub 2018 Jun 19.

DOI:10.4187/respcare.05917

PMID:29921607

Abstract

BACKGROUND

Remote monitoring is increasingly used in patients who receive home mechanical ventilation. The average volume assured pressure support mode is a target volume pressure preset mode that delivers a given tidal volume (V) within a range of controlled inspiratory pressures. In a mode such as this, it is important to verify that the V value retrieved from the ventilator SD card is accurate.

METHODS

A lung model was set with C (Compliance) 0.075 L/cm HO and R (Inspiratory resistance)-R (Expiratory resistance) 15-25 cm HO/L/s (model 1) or with C 0.050 L/cm HO and R 6 cm HO/L/s (model 2) and 6 cm HO effort. Three home-care ventilators (A40, PrismaST30, and Vivo40) were set to average volume assured pressure support mode with 0.3 and 0.6 L V each at PEEP 5 and 10 cm HO, and were connected to the lung model with and without nonintentional leak. The reference airway pressure and flow were measured by a data logger. V was expressed in body temperature and pressure saturated. We assessed the difference in V between the ventilator SD card and a data logger relative to set V and factors associated with its magnitude.

RESULTS

For A40, PrismaST30, and Vivo40, the adjusted mean V differences between the ventilator SD card and the data logger were -0.053 L (95% CI -0.067 to -0.039 L) ( < .001), -0.002 L (95%CI -0.022 to 0.019 L) ( = .86), and -0.067 L (95% CI -0.007 to 0.127 L) ( = .03), respectively. The partial Spearman correlation coefficients between the ventilator SD card and a data logger were 0.89 ( < .001), 0.59 ( < .001), and 0.78 ( < .001), respectively to the ventilators. The relative variations in measured V from the set V were 16.0, -12.0, and 6.7% for the ventilator SD card, and were -2.5, -7.5, and -27.2% for the data logger, respectively. The discrepancy in ventilator between SD card and data logger were influenced by PEEP for the PrismaST30 ventilator, nonintentional leak for the Vivo40 ventilator and PEEP, nonintentional leak, and underlying disease, the effect of each depending on the levels of the other factors, for the A40 ventilator.

CONCLUSIONS

In the 3 home-care ventilators, the ventilator SD card underestimated V. Factors involved in this difference differed among the ventilators.

摘要

背景

远程监测在接受家庭机械通气的患者中越来越常用。平均潮气量保证压力支持模式是一种目标容量压力预设模式，可在一定的控制吸气压力范围内输送给定的潮气量（V）。在这样的模式下，验证从呼吸机SD卡中获取的V值是否准确很重要。

方法

设置一个肺模型，其顺应性（C）为0.075L/cmH₂O，吸气阻力（R）-呼气阻力（R）为15 - 25cmH₂O/L/s（模型1），或C为0.050L/cmH₂O，R为6cmH₂O/L/s（模型2），外加6cmH₂O的用力。三台家用呼吸机（A40、PrismaST30和Vivo40）设置为平均潮气量保证压力支持模式，在呼气末正压（PEEP）为5和10cmH₂O时，V分别为0.3L和0.6L，并在有和无非故意漏气的情况下连接到肺模型。通过数据记录器测量参考气道压力和流量。V以体温和压力饱和状态表示。我们评估了呼吸机SD卡与数据记录器之间V相对于设定V的差异以及与其大小相关的因素。

结果

对于A40、PrismaST30和Vivo40，呼吸机SD卡与数据记录器之间调整后的平均V差异分别为-0.053L（95%置信区间-0.067至-0.039L）（P <.001）、-0.002L（95%置信区间-0.022至0.019L）（P =.86）和-0.067L（95%置信区间-0.007至0.127L）（P =.03）。呼吸机SD卡与数据记录器之间的偏Spearman相关系数分别为0.89（P <.001）、0.59（P <.001）和0.78（P <.001）。相对于设定V，呼吸机SD卡测量的V的相对变化分别为16.0%、-12.0%和6.7%，数据记录器测量的V的相对变化分别为-2.5%、-7.5%和-27.2%。对于PrismaST30呼吸机，SD卡与数据记录器之间的差异受PEEP影响；对于Vivo40呼吸机，受非故意漏气影响；对于A40呼吸机，受PEEP、非故意漏气和基础疾病影响，每种因素的影响取决于其他因素的水平。