在重症监护病房保护性通气的实验台模型中，不同吸入镇静设备对机械功率的影响。
Effects on mechanical power of different devices used for inhaled sedation in a bench model of protective ventilation in ICU.
作者信息
Pellet Pierre-Louis, Stevic Neven, Degivry Florian, Louis Bruno, Argaud Laurent, Guérin Claude, Cour Martin
机构信息
Hospices Civils de Lyon, Service de Médecine Intensive -Réanimation, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France.
Université de Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Est, 69373, Lyon, France.
出版信息
Ann Intensive Care. 2024 Jan 29;14(1):18. doi: 10.1186/s13613-024-01245-x.
BACKGROUND
Inhaled sedation during invasive mechanical ventilation in patients with acute respiratory distress syndrome (ARDS) has received increasing attention. However, inhaled sedation devices increase dead-space ventilation and an undesirable effect is the increase in minute ventilation needed to maintain CO removal. A consequence of raising minute ventilation is an increase in mechanical power (MP) that can promote lung injury. However, the effect of inhaled sedation devices on MP remains unknown.
METHODS
We conducted a bench study to assess and compare the effects of three devices delivering inhaled sevoflurane currently available in ICU (AnaConDa-50 mL (ANA-50), AnaConDa-100 mL (ANA-100), and MIRUS) on MP by using a test lung model set with three compliances (20, 40, and 60 mL/cmHO). We simulated lung-protective ventilation using a low tidal volume and two levels of positive end-expiratory pressure (5 and 15 cmHO) under ambient temperature and dry conditions. Following the insertion of the devices, either the respiratory rate or tidal volume was increased in 15%-steps until end-tidal CO (EtCO) returned to the baseline value. MP was calculated at baseline and after EtCO correction using a simplified equation.
RESULTS
Following device insertion, the EtCO increase was significantly greater with MIRUS (+ 78 ± 13%) and ANA-100 (+ 100 ± 11%) than with ANA-50 (+ 49 ± 7%). After normalizing EtCO by adjusting minute ventilation, MP significantly increased by more than 50% with all inhaled sedation devices compared to controls. The lowest increase in MP was observed with ANA-50 (p < 0.05 versus ANA-100 and MIRUS). The Costa index, another parameter assessing the mechanical energy delivered to the lungs, calculated as driving pressure × 4 + respiratory rate, significantly increased by more than 20% in all experimental conditions. Additional experiments performed under body temperature, ambient pressure, and gas saturated with water vapor conditions, confirmed the main results with an increase in MP > 50% with all devices after normalizing EtCO by adjusting minute ventilation.
CONCLUSION
Inhaled sedation devices substantially increased MP in this bench model of protective ventilation, which might limit their benefits in ARDS.
背景
急性呼吸窘迫综合征（ARDS）患者在有创机械通气期间进行吸入镇静受到了越来越多的关注。然而，吸入镇静设备会增加死腔通气，一个不良影响是为维持二氧化碳清除所需的分钟通气量增加。提高分钟通气量的一个后果是机械功率（MP）增加，这可能会促进肺损伤。然而，吸入镇静设备对机械功率的影响尚不清楚。
方法
我们进行了一项实验台研究，通过使用设置了三种顺应性（20、40和60 mL/cmH₂O）的测试肺模型，评估并比较重症监护病房（ICU）目前可用的三种吸入七氟醚的设备（AnaConDa-50 mL（ANA-50）、AnaConDa-100 mL（ANA-100）和MIRUS）对机械功率的影响。在环境温度和干燥条件下，我们使用低潮气量和两种呼气末正压水平（5和15 cmH₂O）模拟肺保护性通气。插入设备后，呼吸频率或潮气量以15%的步长增加，直到呼气末二氧化碳（EtCO₂）恢复到基线值。使用简化方程在基线和EtCO₂校正后计算机械功率。
结果
插入设备后，MIRUS（+78±13%）和ANA-100（+100±11%）导致的EtCO₂增加显著大于ANA-50（+49±7%）。通过调整分钟通气量使EtCO₂正常化后，与对照组相比，所有吸入镇静设备的机械功率均显著增加超过50%。ANA-50的机械功率增加最低（与ANA-100和MIRUS相比，p<0.05）。另一个评估传递到肺部机械能的参数科斯塔指数，计算为驱动压力×4+呼吸频率，在所有实验条件下均显著增加超过20%。在体温、环境压力和水蒸气饱和气体条件下进行的额外实验证实了主要结果，即通过调整分钟通气量使EtCO₂正常化后，所有设备的机械功率增加>50%。
结论
在这个保护性通气的实验台模型中，吸入镇静设备显著增加了机械功率，这可能会限制它们在ARDS中的益处。
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