各种通气机连续 P 测量的偏倚和精度：一项模拟研究。
Bias and Precision of Continuous P Measurement by Various Ventilators: A Simulation Study.
机构信息
Intensive Care Section, Emergency and Critical Care/General Intensive Care Center, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan.
Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
出版信息
Respir Care. 2023 Oct;68(10):1393-1399. doi: 10.4187/respcare.10755. Epub 2023 May 23.
BACKGROUND
Most ventilators measure airway occlusion pressure (occlusion P) by occluding the breathing circuit; however, some ventilators can predict P for each breath without occlusion. Nevertheless, few studies have verified the accuracy of continuous P measurement. The aim of this study was to evaluate the accuracy of continuous P measurement compared with that of occlusion methods for various ventilators using a lung simulator.
METHODS
A total of 42 breathing patterns were validated using a lung simulator in combination with 7 different inspiratory muscular pressures and 3 different rise rates to simulate normal and obstructed lungs. PB980 and Dräger V500 ventilators were used to obtain occlusion P measurements. The occlusion maneuver was performed on the ventilator, and a corresponding reference P was recorded from the ASL5000 breathing simulator simultaneously. Hamilton-C6, Hamilton-G5, and Servo-U ventilators were used to obtain sustained P measurements (continuous P). The reference P measured with the simulator was analyzed by using a Bland-Altman plot.
RESULTS
The 2 lung mechanical models capable of measuring occlusion P yielded values equivalent to reference P (bias and precision values were 0.51 and 1.06, respectively, for the Dräger V500, and were 0.54 and 0.91, respectively, for the PB980). Continuous P for the Hamilton-C6 was underestimated in both the normal and obstructive models (bias and precision values were -2.13 and 1.91, respectively), whereas continuous P for the Servo-U was underestimated only in the obstructive model (bias and precision values were -0.86 and 1.76, respectively). Continuous P for the Hamilton-G5 was mostly similar to but less accurate than occlusion P (bias and precision values were 1.62 and 2.06, respectively).
CONCLUSIONS
The accuracy of continuous P measurements varies based on the characteristics of the ventilator and should be interpreted by considering the characteristics of each system. Moreover, measurements obtained with an occluded circuit could be desirable for determining the true P.
背景
大多数呼吸机通过阻塞呼吸回路来测量气道闭塞压（occlusion P）；然而，一些呼吸机可以在不阻塞的情况下预测每一次呼吸的 P。尽管如此，很少有研究验证连续 P 测量的准确性。本研究旨在使用肺模拟器评估各种呼吸机的连续 P 测量与阻塞方法相比的准确性。
方法
使用肺模拟器结合 7 种不同的吸气肌压力和 3 种不同的上升率，共验证了 42 种呼吸模式，以模拟正常和阻塞肺。使用 PB980 和 Dräger V500 呼吸机获得闭塞 P 测量值。在呼吸机上进行闭塞操作，并同时从 ASL5000 呼吸模拟器记录相应的参考 P。使用 Hamilton-C6、Hamilton-G5 和 Servo-U 呼吸机获得持续 P 测量值（连续 P）。使用 Bland-Altman 图分析模拟器测量的参考 P。
结果
2 种能够测量闭塞 P 的肺力学模型得出的数值与参考 P 相当（Dräger V500 的偏差和精度值分别为 0.51 和 1.06，PB980 的偏差和精度值分别为 0.54 和 0.91）。在正常和阻塞模型中，Hamilton-C6 的连续 P 均被低估（偏差和精度值分别为-2.13 和 1.91），而 Servo-U 的连续 P 仅在阻塞模型中被低估（偏差和精度值分别为-0.86 和 1.76）。Hamilton-G5 的连续 P 大多与闭塞 P 相似但准确性较低（偏差和精度值分别为 1.62 和 2.06）。
结论
连续 P 测量的准确性因呼吸机的特性而异，应根据每个系统的特性进行解释。此外，通过阻塞回路获得的测量值可能更适合确定真实的 P。
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