经肺压指导的肺保护性通气可改善肥胖机械通气患者的肺力学和氧合。
Transpulmonary Pressure-Guided Lung-Protective Ventilation Improves Pulmonary Mechanics and Oxygenation Among Obese Subjects on Mechanical Ventilation.
机构信息
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.
出版信息
Respir Care. 2021 Jul;66(7):1049-1058. doi: 10.4187/respcare.08686. Epub 2021 Apr 20.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
背景
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。
方法
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。
结果
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。
结论
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。
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