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我如何教授内源性呼气末正压:应用呼气生理学

How I Teach Auto-PEEP: Applying the Physiology of Expiration.

作者信息

Keller Michael, Applefeld Willard, Acho Megan, Lee Burton W

机构信息

Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland.

Department of Cardiology, Duke University School of Medicine, Durham, North Carolina; and.

出版信息

ATS Sch. 2022 Oct 12;3(4):610-624. doi: 10.34197/ats-scholar.2022-0024HT. eCollection 2022 Dec.

DOI:10.34197/ats-scholar.2022-0024HT
PMID:36726712
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9886194/
Abstract

Teaching complex topics in mechanical ventilation can prove challenging for clinical educators, both at the bedside and in the classroom setting. Some of these topics, such as the topic of auto-positive end-expiratory pressure (auto-PEEP), consist of complicated physiological principles that can be difficult to convey in an organized and intuitive manner. In this entry of "How I Teach," we provide an approach to teaching the concept of auto-PEEP to senior residents and fellows working in the intensive care unit. We offer a framework for educators to effectively present the concepts of auto-PEEP to learners, either at the bedside or in the classroom setting, by summarizing key concepts and including concrete examples of the educational techniques we use. This framework includes specific content we emphasize, how to present this content using a variety of educational resources, assessing learner understanding, and how to modify the topic on the basis of location, time, or resource constraints.

摘要

对于临床教育工作者而言,无论是在床边还是课堂环境中,讲授机械通气的复杂主题都颇具挑战性。其中一些主题,比如内源性呼气末正压(auto-PEEP)这一主题,包含了复杂的生理学原理,难以以一种有条理且直观的方式进行传授。在这篇“我的教学方法”文章中,我们提供了一种向重症监护病房工作的高级住院医师和研究员讲授内源性呼气末正压概念的方法。我们为教育工作者提供了一个框架,通过总结关键概念并纳入我们所使用教育技术的具体示例,以便在床边或课堂环境中有效地向学习者呈现内源性呼气末正压的概念。该框架包括我们所强调的具体内容、如何利用各种教育资源呈现这些内容、评估学习者的理解情况,以及如何根据地点、时间或资源限制对主题进行调整。

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How I Teach Auto-PEEP: Applying the Physiology of Expiration.我如何教授内源性呼气末正压:应用呼气生理学
ATS Sch. 2022 Oct 12;3(4):610-624. doi: 10.34197/ats-scholar.2022-0024HT. eCollection 2022 Dec.
2
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Crit Care Med. 1996 Mar;24(3):541-6. doi: 10.1097/00003246-199603000-00028.
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"Auto-PEEP": incidence, magnitude, and contributing factors.“内源性呼气末正压”:发生率、程度及相关因素
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Effect of external PEEP in patients under controlled mechanical ventilation with an auto-PEEP of 5 cmH2O or higher.在自主呼气末正压为5厘米水柱或更高的控制机械通气患者中外部呼气末正压的作用。
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Hemodynamic responses to external counterbalancing of auto-positive end-expiratory pressure in mechanically ventilated patients with chronic obstructive pulmonary disease.慢性阻塞性肺疾病机械通气患者呼气末正压自身阳性外部对抗的血流动力学反应
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Auto-PEEP: how to detect and how to prevent--a review.内源性呼气末正压:如何检测及如何预防——一篇综述
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The ventilatory effects of auto-positive end-expiratory pressure development during cardiopulmonary resuscitation.心肺复苏期间自主呼气末正压形成的通气效应。
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Auto-positive end-expiratory pressure during tracheal gas insufflation: testing a hypothetical model.气管内吹气时的自动呼气末正压:测试一个假设模型。
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Auto-PEEP: an impediment to weaning in the chronically ventilated patient.内源性呼气末正压:慢性通气患者撤机的一个障碍。
AACN Clin Issues Crit Care Nurs. 1991 Aug;2(3):391-7. doi: 10.4037/15597768-1991-3004.

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本文引用的文献

1
Open access spreadsheet application for learning spontaneous breathing mechanics and mechanical ventilation.用于学习自主呼吸力学和机械通气的开放获取电子表格应用程序。
Breathe (Sheff). 2021 Jun;17(2):210012. doi: 10.1183/20734735.0012-2021.
2
Effect of external PEEP in patients under controlled mechanical ventilation with an auto-PEEP of 5 cmH2O or higher.在自主呼气末正压为5厘米水柱或更高的控制机械通气患者中外部呼气末正压的作用。
Ann Intensive Care. 2016 Dec;6(1):53. doi: 10.1186/s13613-016-0158-0. Epub 2016 Jun 16.
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Respiratory mechanics in mechanically ventilated patients.
重塑本科重症医学教育:未来十年之路。
ATS Sch. 2024 Aug 14;5(3):375-385. doi: 10.34197/ats-scholar.2023-0136PS. eCollection 2024 Sep 30.
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"How I Teach": A Novel Guide to Teaching in Pulmonary, Critical Care, and Sleep Medicine.《我如何教学》:肺部、重症监护及睡眠医学教学新指南
ATS Sch. 2022 Dec 30;3(4):509-510. doi: 10.34197/ats-scholar.2022-0122ED. eCollection 2022 Dec.
5
Adjusting ventilator settings to avoid air trapping in extremely premature infants reduces the need for tracheostomy and length of stay.调整呼吸机设置以避免极早产儿出现空气潴留可减少气管切开术的需求及住院时间。
Front Pediatr. 2022 Dec 30;10:1059081. doi: 10.3389/fped.2022.1059081. eCollection 2022.
机械通气患者的呼吸力学
Respir Care. 2014 Nov;59(11):1773-94. doi: 10.4187/respcare.03410. Epub 2014 Oct 21.
4
Expiratory time constant for determinations of plateau pressure, respiratory system compliance, and total resistance.用于测定平台压、呼吸系统顺应性和总阻力的呼气时间常数。
Crit Care. 2013 Feb 5;17(1):R23. doi: 10.1186/cc12500.
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Auto-PEEP in respiratory failure.呼吸衰竭中的自动 PEEP。
Minerva Anestesiol. 2012 Feb;78(2):201-21. Epub 2011 Nov 18.
6
Clinical review: Positive end-expiratory pressure and cardiac output.临床综述:呼气末正压与心输出量
Crit Care. 2005;9(6):607-21. doi: 10.1186/cc3877. Epub 2005 Oct 18.
7
Bedside waveforms interpretation as a tool to identify patient-ventilator asynchronies.床边波形解读作为识别患者-呼吸机不同步的一种工具。
Intensive Care Med. 2006 Jan;32(1):34-47. doi: 10.1007/s00134-005-2828-5. Epub 2005 Nov 9.
8
Measurement of air trapping, intrinsic positive end-expiratory pressure, and dynamic hyperinflation in mechanically ventilated patients.机械通气患者中气体陷闭、内源性呼气末正压和动态肺过度充气的测量。
Respir Care. 2005 Jan;50(1):110-23; discussion 123-4.
9
PARTITIONING OF RESPIRATORY FLOW RESISTANCE IN MAN.人体呼吸流阻的分配
J Appl Physiol. 1964 Jul;19:653-8. doi: 10.1152/jappl.1964.19.4.653.
10
Patient-ventilator interaction.患者与呼吸机的相互作用。
Am J Respir Crit Care Med. 2001 Apr;163(5):1059-63. doi: 10.1164/ajrccm.163.5.2005125.