评估机械通气患儿食管导管球囊充气的最佳容量。

Evaluation of Optimal Esophageal Catheter Balloon Inflation Volume in Mechanically Ventilated Children.

机构信息

Drs Rudolph, Koopman, Blokpoel, and Kneyber are affiliated with the Division of Paediatric Critical Care Medicine, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Dr Kneyber is affiliated with Critical Care, Anaesthesiology, Peri-Operative & Emergency Medicine (CAPE), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

出版信息

Respir Care. 2024 Feb 28;69(3):325-332. doi: 10.4187/respcare.11018.

DOI:10.4187/respcare.11018

PMID:38195144

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10984591/

Abstract

BACKGROUND

Accuracy of esophageal pressure measured by an air-filled esophageal balloon catheter is dependent on balloon filling volume. However, this has been understudied in mechanically ventilated children. We sought to study the optimal filling volume in children receiving ventilation by using previously reported calibration methods. Secondary objectives included to examine the difference in pressure measurements at individualized optimal filling volume versus a standardized inflation volume and to study if a static hold during calibration is required to identify the optimal filling volume.

METHODS

An incremental inflation calibration procedure was performed in children receiving ventilation, <18 y, instrumented with commercially available catheters (6 or 8 French) who were not breathing spontaneously. The balloon was manually inflated by 0.2 to 1.6 mL (6 French) or 2.6 mL (8 French). Esophageal pressure (P) and airway pressure tracings were recorded during the procedure. Data were analyzed offline by using 2 methods: visual determination of filling range with the calculation of the highest difference between expiratory and inspiratory P and determination of a correctly filled balloon by calculating the esophageal elastance.

RESULTS

We enrolled 40 subjects with median (interquartile range [IQR]) age 6.8 (2-25) months. The optimal filling volume ranged from 0.2 to 1.2 mL (median [IQR] 0.6 [0.2-1.0] mL) in the subjects with a 6 French catheter and 0.2-2.0 mL (median [IQR] 0.7 [0.5-1.2] mL) for 8 French catheters. Inflating the balloon with 0.6 mL (median computed from the whole cohort) gave an absolute difference in transpulmonary pressure that ranged from -4 to 7 cm HO compared with the personalized volume. P calculated over 5 consecutives breaths differed with a maximum of 1 cm HO compared to P calculated during a single inspiratory hold. The esophageal elastance was correlated with weight, age, and sex.

CONCLUSIONS

The optimal balloon inflation volume was highly variable, which indicated the need for an individual calibration procedure. P was not overestimated when an inspiratory hold was not applied.

摘要

背景

通过充满空气的食管球囊导管测量食管压力的准确性取决于球囊的充盈体积。然而，这在机械通气的儿童中研究较少。我们试图使用先前报道的校准方法研究接受通气的儿童的最佳填充量。次要目标包括检查个体化最佳填充量与标准化充气量之间的压力测量差异，以及研究在识别最佳填充量时是否需要进行静态保持校准。

方法

在接受通气、<18 岁、使用市售导管（6 或 8 法国）进行仪器测量且未自主呼吸的儿童中进行递增充气校准程序。球囊通过手动充气 0.2 至 1.6 mL（6 法国）或 2.6 mL（8 法国）。在整个过程中记录食管压力（P）和气道压力描记图。通过两种方法离线分析数据：使用计算呼气和吸气 P 之间最大差值的方法直观确定填充范围，以及通过计算食管弹性来确定正确填充的球囊。

结果

我们纳入了 40 名中位（四分位间距[IQR]）年龄为 6.8（2-25）个月的受试者。6 法国导管的最佳填充量范围为 0.2-1.2 mL（中位数[IQR]0.6[0.2-1.0]mL），8 法国导管的最佳填充量范围为 0.2-2.0 mL（中位数[IQR]0.7[0.5-1.2]mL）。用 0.6 mL（根据整个队列计算的中位数）充气会导致跨肺压力的绝对值差异范围为-4 至 7 cm HO，与个性化体积相比。与在单次吸气保持期间计算的 P 相比，连续 5 次呼吸计算的 P 最大差异为 1 cm HO。食管弹性与体重、年龄和性别相关。