基于生理标志物选择最佳呼吸机膨肺技术：一项随机对照交叉研究。
Selecting the best ventilator hyperinflation technique based on physiologic markers: A randomized controlled crossover study.
机构信息
Rehabilitation Sciences Post Graduation Program, Augusto Motta University Center, Rio de Janeiro, RJ, Brazil.
Rehabilitation Sciences Post Graduation Program, Augusto Motta University Center, Rio de Janeiro, RJ, Brazil; Post-graduate Program in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
出版信息
Heart Lung. 2019 Jan;48(1):39-45. doi: 10.1016/j.hrtlng.2018.09.006. Epub 2018 Oct 16.
BACKGROUND
Ventilator hyperinflation (VHI) is effective in improving respiratory mechanics, secretion removal, and gas exchange in mechanically ventilated subjects; however, there are no recommendations for the best ventilator settings to perform the technique.
OBJECTIVE
To compare six modes of VHI, concerning physiological markers of efficacy and safety criteria to support the selection of optimal settings.
METHODS
Thirty mechanically ventilated patients underwent six modes of VHI in a randomized order. The delivered volume, expiratory flow bias criteria, overdistension, patient-ventilator asynchronies and hemodynamic variables were assessed during the interventions.
RESULTS
Volume-controlled ventilation with inspiratory flow of 20 lpm (VC-CMV20) and pressure support ventilation (PSV) achieved the best effectiveness scores (P < 0.05). The target peak pressure of 40 cmHO was associated with a high incidence of overdistension. PSV showed a lower incidence of patient-ventilator asynchronies.
CONCLUSIONS
The modes VC-CMV20 and PSV are the most effective for VHI. Alveolar overdistension and patient-ventilator asynchronies must be considered when applying VHI.
背景
呼吸机过度充气（VHI）可有效改善机械通气患者的呼吸力学、分泌物清除和气体交换；然而，目前尚无关于实施该技术的最佳呼吸机设置的建议。
目的
比较 VHI 的六种模式，涉及疗效的生理标志物和安全性标准，以支持最佳设置的选择。
方法
30 名机械通气患者以随机顺序接受了六种 VHI 模式。在干预过程中评估了输送容量、呼气流量偏置标准、过度充气、患者-呼吸机不同步和血流动力学变量。
结果
吸气流量为 20 lpm 的容量控制通气（VC-CMV20）和压力支持通气（PSV）达到了最佳的效果评分（P < 0.05）。目标峰压为 40 cmHO 与过度充气的发生率较高有关。PSV 显示出较低的患者-呼吸机不同步发生率。
结论
VC-CMV20 和 PSV 模式是 VHI 最有效的模式。在应用 VHI 时，必须考虑肺泡过度充气和患者-呼吸机不同步。
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