通过同步图分析研究机械通气患者的心肺耦合。
Cardiorespiratory coupling in mechanically ventilated patients studied via synchrogram analysis.
作者信息
Ottolina Davide, Cairo Beatrice, Fossali Tommaso, Mazzucco Claudio, Castelli Antonio, Rech Roberto, Catena Emanuele, Porta Alberto, Colombo Riccardo
机构信息
Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, "Luigi Sacco" Hospital - Polo Universitario, Università degli Studi di Milano, Via G.B. Grassi 74, 20157, Milan, Italy.
Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
出版信息
Med Biol Eng Comput. 2023 Jun;61(6):1329-1341. doi: 10.1007/s11517-023-02784-4. Epub 2023 Jan 26.
Respiration and cardiac activity are strictly interconnected with reciprocal influences. They act as weakly coupled oscillators showing varying degrees of phase synchronization and their interactions are affected by mechanical ventilation. The study aims at differentiating the impact of three ventilatory modes on the cardiorespiratory phase coupling in critically ill patients. The coupling between respiration and heartbeat was studied through cardiorespiratory phase synchronization analysis carried out via synchrogram during pressure control ventilation (PCV), pressure support ventilation (PSV), and neurally adjusted ventilatory assist (NAVA) in critically ill patients. Twenty patients were studied under all the three ventilatory modes. Cardiorespiratory phase synchronization changed significantly across ventilatory modes. The highest synchronization degree was found during PCV session, while the lowest one with NAVA. The percentage of all epochs featuring synchronization regardless of the phase locking ratio was higher with PCV (median: 33.9%, first-third quartile: 21.3-39.3) than PSV (median: 15.7%; first-third quartile: 10.9-27.8) and NAVA (median: 3.7%; first-third quartile: 3.3-19.2). PCV induces a significant amount of cardiorespiratory phase synchronization in critically ill mechanically ventilated patients. Synchronization induced by patient-driven ventilatory modes was weaker, reaching the minimum with NAVA. Findings can be explained as a result of the more regular and powerful solicitation of the cardiorespiratory system induced by PCV. The degree of phase synchronization between cardiac and respiratory activities in mechanically ventilated humans depends on the ventilatory mode.
呼吸与心脏活动紧密相连且相互影响。它们如同弱耦合振荡器,呈现出不同程度的相位同步,其相互作用受机械通气影响。本研究旨在区分三种通气模式对重症患者心肺相位耦合的影响。通过在重症患者进行压力控制通气(PCV)、压力支持通气(PSV)和神经调节通气辅助(NAVA)期间,利用同步图进行心肺相位同步分析,研究呼吸与心跳之间的耦合。对20名患者在所有三种通气模式下进行了研究。心肺相位同步在不同通气模式下有显著变化。在PCV期间同步程度最高,而NAVA时最低。无论锁相率如何,具有同步特征的所有时段的百分比,PCV(中位数:33.9%,第一四分位数 - 第三四分位数:21.3 - 39.3)高于PSV(中位数:15.7%;第一四分位数 - 第三四分位数:10.9 - 27.8)和NAVA(中位数:3.7%;第一四分位数 - 第三四分位数:3.3 - 19.2)。PCV在重症机械通气患者中诱导了大量的心肺相位同步。患者驱动的通气模式诱导的同步较弱,NAVA时达到最低。这些发现可以解释为PCV对心肺系统更规律、更有力刺激的结果。机械通气人群中心脏与呼吸活动之间的相位同步程度取决于通气模式。