肺纤维化和普通间质性肺炎模式与原发性 ARDS 患者肺保护性通气的生理效应：一项匹配对照研究。
Physiological effects of lung-protective ventilation in patients with lung fibrosis and usual interstitial pneumonia pattern versus primary ARDS: a matched-control study.
机构信息
Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy.
出版信息
Crit Care. 2023 Oct 18;27(1):398. doi: 10.1186/s13054-023-04682-5.
BACKGROUND
Although patients with interstitial pneumonia pattern (ILD-UIP) and acute exacerbation (AE) leading to severe acute respiratory failure may require invasive mechanical ventilation (MV), physiological data on lung mechanics during MV are lacking. We aimed at describing the physiological effect of lung-protective ventilation in patients with AE-ILD-UIP compared with primary ARDS.
METHODS
Partitioned lung and chest wall mechanics were assessed in a series of AE-ILD-UIP patients matched 1:1 with primary ARDS as controls (based on BMI and PaO/FiO ratio). Three PEEP levels (zero = ZEEP, 4-8 cmHO = PEEP, and titrated to achieve positive end-expiratory transpulmonary pressure P = PEEP) were used for measurements.
RESULTS
Ten AE-ILD-UIP patients and 10 matched ARDS were included. In AE-ILD-UIP median P at ZEEP was - 4.3 [- 7.6- - 2.3] cmHO and lung elastance (E) 44 [40-51] cmHO/L. At PEEP, P remained negative and E did not change (p = 0.995) versus ZEEP. At PEEP, P increased to 0.8 [0.3-1.5] cmHO and E to 49 [43-59] (p = 0.004 and p < 0.001 compared to ZEEP and PEEP, respectively). ΔP decreased at PEEP (p = 0.018) and increased at PEEP (p = 0.003). In matched ARDS control PEEP titration to obtain a positive P did not result in significant changes in E and ΔP.
CONCLUSIONS
In mechanically ventilated AE-ILD-UIP patients, differently than in patients with primary ARDS, PEEP titrated to obtain a positive P significantly worsened lung mechanics.
背景
尽管患有间质性肺炎模式（ILD-UIP）和导致严重急性呼吸衰竭的急性加重（AE）的患者可能需要有创机械通气（MV），但 MV 期间肺力学的生理数据却很缺乏。我们的目的是描述 AE-ILD-UIP 患者与原发性 ARDS 患者相比，肺保护性通气的生理效应。
方法
在一系列 AE-ILD-UIP 患者中评估分割的肺和胸壁力学，这些患者与原发性 ARDS 患者按 1:1 匹配作为对照组（基于 BMI 和 PaO/FiO 比值）。使用三个 PEEP 水平（零=ZEEP、4-8 cmHO=PEEP 和滴定以达到正呼气末跨肺压 P=PEEP）进行测量。
结果
纳入了 10 名 AE-ILD-UIP 患者和 10 名匹配的 ARDS 患者。在 AE-ILD-UIP 中，ZEEP 时的中位 P 为-4.3[-7.6--2.3]cmHO，肺弹性（E）为 44[40-51]cmHO/L。在 PEEP 时，P 仍为负值，E 没有变化（p=0.995 与 ZEEP 相比）。在 PEEP 时，P 增加到 0.8[0.3-1.5]cmHO，E 增加到 49[43-59]（p=0.004 和 p<0.001 与 ZEEP 和 PEEP 相比）。在 PEEP 时，ΔP 减少（p=0.018），在 PEEP 时增加（p=0.003）。在匹配的 ARDS 对照组中，通过 PEEP 滴定获得正 P 并没有导致 E 和ΔP 的显著变化。
结论
在接受机械通气的 AE-ILD-UIP 患者中，与原发性 ARDS 患者不同，通过 PEEP 滴定获得正 P 会显著恶化肺力学。
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