Pulmonary Diagnostics & Respiratory Therapy Services, University of Virginia Medical Center, Charlottesville, Virginia.
Division of Pulmonary & Critical Care Medicine, University of Virginia Medical Center, Charlottesville, Virginia.
Respir Care. 2021 Jul;66(7):1049-1058. doi: 10.4187/respcare.08686. Epub 2021 Apr 20.
Transpulmonary pressure (P) is used to assess pulmonary mechanics and guide lung-protective mechanical ventilation (LPV). P is recommended to individualize LPV settings for patients with high pleural pressures and hypoxemia. We aimed to determine whether P-guided LPV settings, pulmonary mechanics, and oxygenation improve and differ from non-P-guided LPV among obese patients after 24 h on mechanical ventilation. Secondary outcomes included classification of hypoxemia severity, count of ventilator-free days, ICU length of stay, and overall ICU mortality.
This is a retrospective analysis of data. Ventilator settings, pulmonary mechanics, and oxygenation were recorded on the initial day of P measurement and 24 h later. P-guided LPV targeted inspiratory P < 20 cm HO and expiratory P of 0-6 cm HO. Comparisons were made to repeat measurements.
Twenty subjects (13 male) with median age of 49 y, body mass index 47.5 kg/m, and SOFA score of 8 were included in our analysis. Fourteen subjects received care in a medical ICU. P measurement occurred 16 h after initiating non-P-guided LPV. P-guided LPV resulted in higher median PEEP (14 vs 18 cm HO, = .009), expiratory P (-3 vs 1 cm HO, = .02), respiratory system compliance (30.7 vs 44.6 mL/cm HO, = .001), and [Formula: see text] (156 vs 240 mm Hg, = .002) at 24 h. P-guided LPV resulted in lower [Formula: see text] (0.53 vs 0.33, < .001) and lower P driving pressure (10 vs 6 cm HO, = .001). Tidal volume (420 vs 435 mL, = .64) and inspiratory P (7 vs 7 cm HO, = .90) were similar. Subjects had a median of 7 ventilator-free days, and median ICU length of stay was 14 d. Three of 20 subjects died within 28 d after ICU admission.
P-guided LPV resulted in higher PEEP, lower [Formula: see text], improved pulmonary mechanics, and greater oxygenation when compared to non-P-guided LPV settings in adult obese subjects.
跨肺压（P）用于评估肺力学并指导肺保护性机械通气（LPV）。对于胸膜压高和低氧血症患者，建议使用 P 来个性化 LPV 设置。我们旨在确定肥胖患者机械通气 24 小时后，P 指导的 LPV 设置、肺力学和氧合是否改善，并与非 P 指导的 LPV 不同。次要结局包括低氧血症严重程度分类、无呼吸机天数、重症监护病房（ICU）住院时间和 ICU 总死亡率。
这是一项数据回顾性分析。在测量 P 的初始日和 24 小时后记录呼吸机设置、肺力学和氧合情况。P 指导的 LPV 目标吸气 P < 20 cm H2O 和呼气 P 为 0-6 cm H2O。与重复测量进行比较。
我们的分析纳入了 20 名受试者（13 名男性），中位年龄为 49 岁，体重指数为 47.5 kg/m2，SOFA 评分为 8。14 名受试者在医疗 ICU 接受治疗。P 测量发生在开始非 P 指导的 LPV 后 16 小时。P 指导的 LPV 导致更高的中位 PEEP（14 对 18 cm H2O， =.009）、呼气 P（-3 对 1 cm H2O， =.02）、呼吸系统顺应性（30.7 对 44.6 mL/cm H2O， =.001）和[Formula: see text]（156 对 240 mm Hg， =.002）在 24 小时时。P 指导的 LPV 导致更低的[Formula: see text]（0.53 对 0.33， <.001）和更低的驱动压（10 对 6 cm H2O， =.001）。潮气量（420 对 435 mL， =.64）和吸气 P（7 对 7 cm H2O， =.90）相似。受试者的中位无呼吸机天数为 7 天，中位 ICU 住院时间为 14 天。20 名受试者中有 3 名在 ICU 入院后 28 天内死亡。
与非 P 指导的 LPV 设置相比，肥胖成年患者机械通气 24 小时后，P 指导的 LPV 可导致更高的 PEEP、更低的[Formula: see text]、改善的肺力学和更高的氧合。
