Saghaei Mahmoud, Abbasi Saeed, Alikiaii Babak, Pakzad Moghadam Sayed Hamid
Department of Anesthesiology, School of Medicine, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2023 Feb 25;12:46. doi: 10.4103/abr.abr_293_21. eCollection 2023.
It is important to synchrony the time, intensity, and respiratory signal of the phrenic nerve between the patient and the ventilator. This study aimed to evaluate the effect of switching from volume-controlled to pressure-controlled ventilation on respiratory distress and asynchrony index improvement.
In this randomized controlled clinical trial, 70 patients admitted to the intensive care unit under mechanical ventilation were included. Asynchronous evaluation was performed by examining the patient and evaluating and analyzing the graphic flow curve and ventilator pressure, which included trigger and flow asynchronous and asynchronous cycling. In the intervention group, the mode of ventilation was switched to PSIMV such that peak inspiratory pressures would be equivalent to positive end-expiratory pressure (PEEP) in the volume-controlled mode. Finally, again at 60, 75, and 90 min, information about the ventilator and the patient's symptoms, and arterial carbon dioxide levels were sent by arterial gas sample. The asynchronous index was also recorded in both groups.
This study showed that the mean of variables such as height, ideal body weight, tidal volume, set rate; Sense, FiO, PEEP did not differ significantly between the two groups. The mean of asynchrony was significantly reduced in both control group (16.51 ± 3.35-14.51 ± 2.90; < 0.001) and intervention group (18.26 ± 6.13-13.32 ± 5.53; < 0.001).
Regardless of the type and severity of the disease, switching the ventilation mode from volume-controlled to pressure-controlled can improve patient adaptation to the ventilator, especially in cases with frequent asynchrony.
使患者与呼吸机之间的膈神经时间、强度和呼吸信号同步非常重要。本研究旨在评估从容量控制通气转换为压力控制通气对呼吸窘迫和同步指数改善的影响。
在这项随机对照临床试验中，纳入了70例在重症监护病房接受机械通气的患者。通过检查患者并评估和分析图形流量曲线及呼吸机压力进行异步评估，其中包括触发和流量异步以及异步切换。在干预组中，通气模式切换为压力支持间歇指令通气（PSIMV），以使吸气峰压等同于容量控制模式下的呼气末正压（PEEP）。最后，在60、75和90分钟时，再次通过动脉血气样本获取有关呼吸机和患者症状以及动脉二氧化碳水平的信息。两组均记录同步指数。
本研究表明，两组之间身高、理想体重、潮气量、设定频率、灵敏度、吸入氧浓度、呼气末正压等变量的均值无显著差异。对照组（16.51±3.35 - 14.51±2.90；P<0.001）和干预组（18.26±6.13 - 13.32±5.53；P<0.001）的同步均值均显著降低。
无论疾病类型和严重程度如何，将通气模式从容量控制转换为压力控制均可改善患者对呼吸机的适应性，尤其是在频繁出现不同步的情况下。
