Chen Xiaofeng, Xiong Ruyang, Zhang Ming, Guan Chunming, Feng Liwei, Yao Zhipeng, Li Yue, Liu Wenhua, Ye Ming, Li Yunlong, Jiang Xuesong, Tang Yonglin, Wang Hongliang, Zheng Junbo
Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang, PR China.
Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang, PR China; Department of Intensive Care Medicine, The Arong Banner People's Hospital, Hulunbuir 162750, Inner Mongolia Autonomous Region, PR China.
Intensive Crit Care Nurs. 2024 Dec;85:103782. doi: 10.1016/j.iccn.2024.103782. Epub 2024 Aug 7.
The study aimed to evaluate the improvements in pulmonary ventilation following a sitting position in ventilated ARDS patients using electrical impedance tomography.
A total of 17 patients with ARDS under mechanical ventilation participated in this study, including 8 with moderate ARDS and 9 with severe ARDS. Each patient was initially placed in the supine position (S1), transitioned to sitting position (SP) for 30 min, and then returned to the supine position (S2). Patients were monitored for each period, with parameters recorded.
The primary outcome included the spatial distribution parameters of EIT, regional of interest (ROI), end-expiratory lung impedance (ΔEELI), and parameters of respiratory mechanics.
Compared to S1, the SP significantly altered the distribution in ROI1 (11.29 ± 4.70 vs 14.88 ± 5.00 %, p = 0.003) and ROI2 (35.59 ± 8.99 vs 44.65 ± 6.97 %, p ＜ 0.001), showing reductions, while ROI3 (39.71 ± 11.49 vs 33.06 ± 6.34 %, p = 0.009), ROI4 (13.35 ± 8.76 vs 7.24 ± 5.23 %, p ＜ 0.001), along with peak inspiratory pressure (29.24 ± 3.96 vs 27.71 ± 4.00 cmHO, p = 0.036), showed increases. ΔEELI decreased significantly ventrally (168.3 (40.33 - 189.5), p ＜ 0.0001) and increased significantly dorsally (461.7 (297.5 - 683.7), p ＜ 0.0001). The PaO/FiO ratio saw significant improvement in S2 compared to S1 after 30 min in the seated position (108 (73 - 130) vs 96 (57 - 129) mmHg, p = 0.03).
The sitting position is associated with enhanced compliance, improved oxygenation, and more homogenous ventilation in patients with ventilated ARDS compared to the supine position.
It is important to know the impact of postural changes on patient pulmonary ventilation in order to standardize safe practices in critically ill patients. It may be helpful in the management among ventilated patients.
本研究旨在使用电阻抗断层扫描技术评估通气的急性呼吸窘迫综合征（ARDS）患者采取坐位后肺通气的改善情况。
共有17例接受机械通气的ARDS患者参与本研究，其中中度ARDS患者8例，重度ARDS患者9例。每位患者最初取仰卧位（S1），转为坐位（SP）30分钟，然后再回到仰卧位（S2）。对每个阶段的患者进行监测并记录参数。
主要观察指标包括电阻抗断层扫描的空间分布参数、感兴趣区域（ROI）、呼气末肺阻抗（ΔEELI）以及呼吸力学参数。
与S1相比，SP显著改变了ROI1（11.29±4.70%对14.88±5.00%，p = 0.003）和ROI2（35.59±8.99%对44.65±6.97%，p＜0.001）的分布，呈降低趋势，而ROI3（39.71±11.49%对33.06±6.34%，p = 0.009）、ROI4（13.35±8.76%对7.24±5.23%，p＜0.001）以及吸气峰压（29.24±3.96对27.71±4.00 cmH₂O，p = 0.036）呈升高趋势。腹侧的ΔEELI显著降低（168.3（40.33 - 189.5）），p＜0.0001），背侧显著升高（461.7（297.5 - 683.7），p＜0.0001）。坐位30分钟后，S2时的PaO₂/FiO₂比值与S1相比有显著改善（108（73 - 130）对96（57 - 129）mmHg，p = 0.03）。
与仰卧位相比，坐位可使通气的ARDS患者顺应性增强、氧合改善且通气更均匀。
了解体位变化对患者肺通气的影响对于规范重症患者的安全操作很重要。这可能有助于通气患者的管理。
