一种以最低呼吸功和呼吸力为目标的闭环通气模式可降低中重度急性呼吸窘迫综合征患者的跨肺驱动压。
A closed-loop ventilation mode that targets the lowest work and force of breathing reduces the transpulmonary driving pressure in patients with moderate-to-severe ARDS.
作者信息
Buiteman-Kruizinga Laura A, van Meenen David M P, Bos Lieuwe D J, van der Heiden Pim L J, Paulus Frederique, Schultz Marcus J
机构信息
Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands.
Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.
出版信息
Intensive Care Med Exp. 2023 Jul 14;11(1):42. doi: 10.1186/s40635-023-00527-1.
INTRODUCTION
The driving pressure (ΔP) has an independent association with outcome in patients with acute respiratory distress syndrome (ARDS). INTELLiVENT-Adaptive Support Ventilation (ASV) is a closed-loop mode of ventilation that targets the lowest work and force of breathing.
AIM
To compare transpulmonary and respiratory system ΔP between closed-loop ventilation and conventional pressure controlled ventilation in patients with moderate-to-severe ARDS.
METHODS
Single-center randomized cross-over clinical trial in patients in the early phase of ARDS. Patients were randomly assigned to start with a 4-h period of closed-loop ventilation or conventional ventilation, after which the alternate ventilation mode was selected. The primary outcome was the transpulmonary ΔP; secondary outcomes included respiratory system ΔP, and other key parameters of ventilation.
RESULTS
Thirteen patients were included, and all had fully analyzable data sets. Compared to conventional ventilation, with closed-loop ventilation the median transpulmonary ΔP with was lower (7.0 [5.0-10.0] vs. 10.0 [8.0-11.0] cmHO, mean difference - 2.5 [95% CI - 2.6 to - 2.1] cmHO; P = 0.0001). Inspiratory transpulmonary pressure and the respiratory rate were also lower. Tidal volume, however, was higher with closed-loop ventilation, but stayed below generally accepted safety cutoffs in the majority of patients.
CONCLUSIONS
In this small physiological study, when compared to conventional pressure controlled ventilation INTELLiVENT-ASV reduced the transpulmonary ΔP in patients in the early phase of moderate-to-severe ARDS. This closed-loop ventilation mode also led to a lower inspiratory transpulmonary pressure and a lower respiratory rate, thereby reducing the intensity of ventilation. Trial registration Clinicaltrials.gov, NCT03211494, July 7, 2017. https://clinicaltrials.gov/ct2/show/NCT03211494?term=airdrop&draw=2&rank=1 .
引言
驱动压力（ΔP）与急性呼吸窘迫综合征（ARDS）患者的预后独立相关。INTELLiVENT-自适应支持通气（ASV）是一种闭环通气模式，旨在实现最低的呼吸功和呼吸力。
目的
比较中重度ARDS患者在闭环通气和传统压力控制通气时的跨肺和呼吸系统ΔP。
方法
对处于ARDS早期的患者进行单中心随机交叉临床试验。患者被随机分配先进行4小时的闭环通气或传统通气，之后选择交替的通气模式。主要结局是跨肺ΔP；次要结局包括呼吸系统ΔP以及其他关键通气参数。
结果
纳入13例患者，所有患者均有可完全分析的数据集。与传统通气相比，闭环通气时跨肺ΔP的中位数更低（7.0[5.0 - 10.0] vs. 10.0[8.0 - 11.0] cmH₂O，平均差值 -2.5[95%CI -2.6至 -2.1] cmH₂O；P = 0.0001）。吸气跨肺压和呼吸频率也更低。然而，闭环通气时潮气量更高，但大多数患者的潮气量仍低于普遍接受的安全阈值。
结论
在这项小型生理学研究中，与传统压力控制通气相比，INTELLiVENT-ASV降低了中重度ARDS早期患者的跨肺ΔP。这种闭环通气模式还导致吸气跨肺压和呼吸频率降低，从而降低了通气强度。试验注册Clinicaltrials.gov，NCT03211494，2017年7月7日。https://clinicaltrials.gov/ct2/show/NCT03211494?term=airdrop&draw=2&rank=1 。
Zotero 插件