急性呼吸窘迫综合征实验模型中高频振荡通气期间的最佳平均气道压力：基于电阻抗断层成像的方法

Optimal mean airway pressure during high-frequency oscillatory ventilation in an experimental model of acute respiratory distress syndrome: EIT-based method.

作者信息

Liu Songqiao, Zhao Zhanqi, Tan Li, Wang Lihui, Möller Knut, Frerichs Inéz, Yu Tao, Huang Yingzi, Pan Chun, Yang Yi, Qiu Haibo

机构信息

Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Jiangsu Province, Nanjing, 210009, China.

Institute of Technical Medicine, Furtwangen University, Jakob-Kienzle Strasse 17, 78054, VS-Schwenningen, Germany.

出版信息

Ann Intensive Care. 2020 Mar 6;10(1):31. doi: 10.1186/s13613-020-0647-z.

DOI:10.1186/s13613-020-0647-z

PMID:32144514

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7060304/

Abstract

BACKGROUND

High-frequency oscillatory ventilation (HFOV) may theoretically provide lung protective ventilation. The negative clinical results may be due to inadequate mean airway pressure (mPaw) settings in HFOV. Our objective was to evaluate the air distribution, ventilatory and hemodynamic effects of individual mPaw titration during HFOV in ARDS animal based on oxygenation and electrical impedance tomography (EIT).

METHODS

ARDS was introduced with repeated bronchoalveolar lavage followed by injurious mechanical ventilation in ten healthy male pigs (51.2 ± 1.9 kg). Settings of HFOV were 9 Hz (respiratory frequency), 33% (inspiratory time) and 70 cmHO (∆pressure). After lung recruitment, the mPaw was reduced in steps of 3 cmHO every 6 min. Hemodynamics and blood gases were obtained in each step. Regional ventilation distribution was determined with EIT.

RESULTS

PaO/FiO decreased significantly during the mPaw decremental phase (p < 0.001). Lung overdistended regions decreased, while recruitable regions increased as mPaw decreased. The optimal mPaw with respect to PaO/FiO was 21 (18.0-21.0) cmHO, that is comparable to EIT-based center of ventilation (EIT-CoV) and EIT-collapse/over, 19.5 (15.0-21.0) and 19.5 (18.0-21.8), respectively (p = 0.07). EIT-CoV decreasing along with mPaw decrease revealed redistribution toward non-dependent regions. The individual mPaw titrated by EIT-based indices improved regional ventilation distribution with respect to overdistension and collapse (p = 0.035).

CONCLUSION

Our data suggested personalized optimal mPaw titration by EIT-based indices improves regional ventilation distribution and lung homogeneity during high-frequency oscillatory ventilation.

摘要

背景

高频振荡通气（HFOV）理论上可提供肺保护性通气。其负面临床结果可能归因于HFOV中平均气道压（mPaw）设置不当。我们的目的是基于氧合和电阻抗断层扫描（EIT）评估急性呼吸窘迫综合征（ARDS）动物在HFOV期间个体mPaw滴定的气体分布、通气和血流动力学效应。

方法

对10头健康雄性猪（51.2±1.9 kg）进行反复支气管肺泡灌洗并给予有害机械通气以诱导ARDS。HFOV设置为9 Hz（呼吸频率）、33%（吸气时间）和70 cmH₂O（压差）。肺复张后，每6分钟以3 cmH₂O的步长降低mPaw。每一步均获取血流动力学和血气数据。用EIT确定区域通气分布。

结果

在mPaw递减阶段，PaO₂/FiO₂显著降低（p<0.001）。随着mPaw降低，肺过度膨胀区域减少，可复张区域增加。关于PaO₂/FiO₂的最佳mPaw为21（18.0 - 21.0）cmH₂O，分别与基于EIT的通气中心（EIT-CoV）和EIT-塌陷/过度膨胀相当，后者分别为19.5（15.0 - 21.0）和19.5（18.0 - 21.8）（p = 0.07）。EIT-CoV随mPaw降低而降低，表明向非依赖区域重新分布。基于EIT指标滴定的个体mPaw改善了过度膨胀和塌陷方面的区域通气分布（p = 0.０35）。