Liu Ling, Yu Yue, Xu Xiaoting, Sun Qin, Qiu Haibo, Chiumello Davide, Yang Yi
Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
SC Anesthesia and Resuscitation, San Paolo Hospital-University Campus, ASST Santi Paolo e Carlo, Milan, Italy.
Front Med (Lausanne). 2021 Nov 12;8:752508. doi: 10.3389/fmed.2021.752508. eCollection 2021.
Patient-ventilator asynchrony is common during pressure support ventilation (PSV) because of the constant cycling-off criteria and variation of respiratory system mechanical properties in individual patients. Automatic adjustment of inspiratory triggers and cycling-off criteria based on waveforms might be a useful tool to improve patient-ventilator asynchrony during PSV. Twenty-four patients were enrolled and were ventilated using PSV with different cycling-off criteria of 10% (PS), 30% (PS), 50% (PS), and automatic adjustment PSV (PS). Patient-ventilator interactions were measured. The total asynchrony index (AI) and NeuroSync index were consistently lower in PS when compared with PS, PS, and PS, ( < 0.05). The benefit of PS in reducing the total AI was mainly because of the reduction of the micro-AI but not the macro-AI. PS significantly improved the relative cycling-off error when compared with prefixed controlled PSV ( < 0.05). PS significantly reduced the trigger error and inspiratory effort for the trigger when compared with a prefixed trigger. However, total inspiratory effort, breathing patterns, and respiratory drive were not different among modes. When compared with fixed cycling-off criteria, an automatic adjustment system improved patient-ventilator asynchrony without changes in breathing patterns during PSV. The automatic adjustment system could be a useful tool to titrate more personalized mechanical ventilation.
由于持续的切换标准以及个体患者呼吸系统机械特性的变化，患者 - 呼吸机不同步在压力支持通气（PSV）期间很常见。基于波形自动调整吸气触发和切换标准可能是改善PSV期间患者 - 呼吸机不同步的有用工具。招募了24名患者，使用具有10%（PS）、30%（PS）、50%（PS）不同切换标准的PSV以及自动调整PSV（PS）进行通气。测量患者 - 呼吸机相互作用。与PS、PS和PS相比，PS时的总不同步指数（AI）和神经同步指数持续较低（<0.05）。PS在降低总AI方面的益处主要是由于微AI的降低而非宏AI。与固定控制的PSV相比，PS显著改善了相对切换误差（<0.05）。与固定触发相比，PS显著降低了触发误差和触发时的吸气努力。然而，不同模式之间的总吸气努力、呼吸模式和呼吸驱动并无差异。与固定切换标准相比，自动调整系统在PSV期间改善了患者 - 呼吸机不同步，且呼吸模式无变化。自动调整系统可能是滴定更个性化机械通气的有用工具。
