Anesthesia and General Intensive Care, "Maggiore della Carità" University Hospital, Novara, Italy.
Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
J Crit Care. 2021 Feb;61:125-132. doi: 10.1016/j.jcrc.2020.10.021. Epub 2020 Oct 24.
Optimal esophageal balloon filling volume (V) depends on the intrathoracic pressure. During Sigh breath delivered by the ventilator machine, esophageal balloon is surrounded by elevated intrathoracic pressure that might require higher filling volume for accurate measure of tidal changes in esophageal pressure (Pes). The primary aim of our investigation was to evaluate and compare V during volume controlled and pressure support breaths vs. Sigh breath.
Twenty adult patients requiring invasive volume-controlled ventilation (VCV) for hypoxemic acute respiratory failure were enrolled. After the insertion of a naso-gastric catheter equipped with 10 ml esophageal balloon, each patient underwent three 30-min trials as follows: VCV, pressure support ventilation (PSV), and PSV + Sigh. Sigh was added to PSV as 35 cmHO pressure-controlled breath over 4 s, once per minute. PSV and PSV + Sigh were randomly applied and, at the end of each step, esophageal balloon calibration was performed.
V was higher for Sigh breath (4.5 [3.0-6.8] ml) compared to VCV (1.5 [1.0-2.9] ml, P = 0.0004) and PSV tidal breath (1.0 [0.5-2.4] ml, P < 0.0001).
During Sigh breath, applying a calibrated approach for Pes assessment, a higher V was required compared to VCV and PSV tidal breath.
最佳食管球囊充盈量（V）取决于胸腔内压力。在呼吸机机器提供的叹息呼吸期间，食管球囊周围环绕着升高的胸腔内压力，这可能需要更高的充盈量才能准确测量食管压力（Pes）的潮气量变化。我们研究的主要目的是评估和比较容量控制和压力支持呼吸与叹息呼吸时的 V。
纳入 20 例需要低氧性急性呼吸衰竭进行有创容量控制通气（VCV）的成年患者。在插入装有 10ml 食管球囊的鼻胃管后，每位患者接受了以下三个 30 分钟的试验：VCV、压力支持通气（PSV）和 PSV+叹息。叹息是通过每分钟 1 次的 4 秒内施加 35cmHO 压力控制的呼吸添加到 PSV 中。PSV 和 PSV+叹息被随机应用，并且在每个步骤结束时进行食管球囊校准。
与 VCV（1.5[1.0-2.9]ml，P=0.0004）和 PSV 潮气呼吸（1.0[0.5-2.4]ml，P<0.0001）相比，叹息呼吸时的 V 更高（4.5[3.0-6.8]ml）。
在叹息呼吸期间，为了评估 Pes，应用校准方法，与 VCV 和 PSV 潮气呼吸相比，需要更高的 V。
