Department of Anaesthesiology and Critical Care Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68165 Mannheim, Germany.
Department of Surgical Sciences and Integrated Diagnostics, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, University of Genoa, Genoa, Italy.
J Crit Care. 2018 Dec;48:433-442. doi: 10.1016/j.jcrc.2018.10.005. Epub 2018 Oct 10.
Pulmonary recruitment and positive end-expiratory pressure (PEEP) titrated according to minimal static elastance of the respiratory system (PEEP) compared to PEEP set according to the ARDSNetwork table (PEEP) as a strategy to prevent ventilator-associated lung injury (VALI) in patients with acute respiratory distress syndrome (ARDS) increases mortality. Alternatively, avoiding negative end-expiratory transpulmonary pressure has been discussed as superior PEEP titration strategy. Therefore, we tested whether PEEP or PEEP prevent negative end-expiratory transpulmonary pressure in ARDS patients.
Thirteen patients with moderate to severe ARDS were studied at PEEP versus PEEP. Patients were then grouped post hoc according to the end-expiratory transpulmonary pressure (positive or negative).
7 out of 13 patients showed negative end-expiratory transpulmonary pressures (Ptp-) with both strategies (PEEP: - 5.4 ± 3.5 vs. 2.2 ± 3.7 cm HO, p = .005; PEEP: - 3.6 ± 1.5 vs. 3.5 ± 3.3 cm HO, p < .001). Ptp- was associated with higher intra-abdominal pressure and lower end-expiratory lung volume with both PEEP strategies.
In patients with moderate-to-severe ARDS, PEEP titrated according to the minimal static elastance of the respiratory system or according to the ARDSNetwork table did not prevent negative end-expiratory transpulmonary pressure.
与根据 ARDSNetwork 表设置的呼气末正压（PEEP）相比，根据呼吸系统最小静态顺应性滴定的 PEEP（PEEP）作为预防急性呼吸窘迫综合征（ARDS）患者呼吸机相关性肺损伤（VALI）的策略，增加了死亡率。另一方面，避免呼气末跨肺压为负已被讨论为更优的 PEEP 滴定策略。因此，我们测试了 PEEP 或 PEEP 是否可以预防 ARDS 患者的呼气末跨肺压为负。
在 PEEP 与 PEEP 比较中，研究了 13 例中重度 ARDS 患者。然后根据呼气末跨肺压（正压或负压）将患者进行事后分组。
两种策略下，有 7 例患者出现呼气末跨肺压为负（Ptp-）（PEEP：-5.4±3.5 与 2.2±3.7 cmH2O，p=0.005；PEEP：-3.6±1.5 与 3.5±3.3 cmH2O，p<0.001）。两种 PEEP 策略下，Ptp-与更高的腹腔内压和更低的呼气末肺容积相关。
在中重度 ARDS 患者中，根据呼吸系统最小静态顺应性或根据 ARDSNetwork 表滴定的 PEEP 并不能预防呼气末跨肺压为负。
