跨肺压对急性呼吸窘迫综合征期间右心室损伤发生率的影响：一项成人和儿童的初步研究
Impact of the transpulmonary pressure on right ventricle impairment incidence during acute respiratory distress syndrome: a pilot study in adults and children.
作者信息
Vedrenne-Cloquet Meryl, Petit Matthieu, Khirani Sonia, Charron Cyril, Khraiche Diala, Panaioli Elena, Habib Mustafa, Renolleau Sylvain, Fauroux Brigitte, Vieillard-Baron Antoine
机构信息
Service de Réanimation et Surveillance Continue Médicochirurgicale Pédiatrique, Necker Hospital, APHP, 149 Rue de Sèvres, 75015, Paris, France.
Unité de Ventilation Non Invasive et du Sommeil de l'enfant, EA7330 VIFASOM, Université Paris Cité, Paris, France.
出版信息
Intensive Care Med Exp. 2024 Sep 27;12(1):84. doi: 10.1186/s40635-024-00671-2.
BACKGROUND
Right ventricle impairment (RVI) is common during acute respiratory distress syndrome (ARDS) in adults and children, possibly mediated by the level of transpulmonary pressure (P). We sought to investigate the impact of the level of P on ARDS-associated right ventricle impairment (RVI).
METHODS
Adults and children (> 72 h of life) were included in this two centers prospective study if they were ventilated for a new-onset ARDS or pediatric ARDS, without spontaneous breathing and contra-indication to esophageal catheter. Serial measures of static lung, chest wall, and respiratory mechanics were coupled to critical care echocardiography (CCE) for 3 days. Mixed-effect logistic regression models tested the impact of lung stress (ΔP) along with age, lung injury severity, and carbon dioxide partial pressure, on RVI using two definitions: acute cor pulmonale (ACP), and RV dysfunction (RVD). ACP was defined as a dilated RV with septal dyskinesia; RVD was defined as a composite criterion using tricuspid annular plane systolic excursion, S wave velocity, and fractional area change.
RESULTS
46 patients were included (16 children, 30 adults) with 106 CCE (median of 2 CCE/patient). At day one, 19% of adults and 4/7 children > 1 year exhibited ACP, while 59% of adults and 44% of children exhibited RVD. In the entire population, ACP was present on 17/75 (23%) CCE. ACP was associated with an increased lung stress (mean ΔP of 16.2 ± 6.6 cmHO in ACP vs 11.3 ± 3.6 cmHO, adjusted OR of 1.33, CI95% [1.11-1.59], p = 0.002) and being a child. RVD was present in 59/102 (58%) CCE and associated with lung stress. In children > 1 year, PEEP was significantly lower in case of ACP (9.3 [8.6; 10.0] cmHO in ACP vs 15.0 [11.9; 16.3] cmHO, p = 0.03).
CONCLUSION
Lung stress was associated with RVI in adults and children with ARDS, children being particularly susceptible to RVI. Trial registration Clinical trials identifier: NCT0418467.
背景
在成人和儿童急性呼吸窘迫综合征（ARDS）期间，右心室功能障碍（RVI）很常见，可能由跨肺压（P）水平介导。我们试图研究P水平对ARDS相关右心室功能障碍（RVI）的影响。
方法
纳入因新发ARDS或儿童ARDS进行机械通气、无自主呼吸且无食管导管置入禁忌证的成人和儿童（>72小时）。连续3天对静态肺、胸壁和呼吸力学进行测量，并结合重症监护超声心动图（CCE）。混合效应逻辑回归模型使用急性肺心病（ACP）和右心室功能障碍（RVD）这两种定义，测试肺应力（ΔP）以及年龄、肺损伤严重程度和二氧化碳分压对RVI的影响。ACP定义为右心室扩张伴室间隔运动障碍；RVD定义为使用三尖瓣环平面收缩期位移、S波速度和面积变化分数的综合标准。
结果
纳入46例患者（16例儿童，30例成人），共进行106次CCE（每位患者中位数为2次CCE）。在第1天，19%的成人和4/7例>1岁儿童出现ACP，而59%的成人和44%的儿童出现RVD。在全部人群中，17/75（23%）次CCE出现ACP。ACP与肺应力增加相关（ACP组平均ΔP为16.2±6.6 cmH₂O，而对照组为11.3±3.6 cmH₂O，调整后的OR为1.33，95%CI[1.11-1.59]，p=0.002）以及与儿童相关。59/102（58%）次CCE出现RVD，且与肺应力相关。在>1岁儿童中，出现ACP时呼气末正压（PEEP）显著更低（ACP组为9.3[8.6；10.0]cmH₂O，而对照组为15.0[11.9；16.3]cmH₂O，p=0.03）。
结论
肺应力与ARDS成人和儿童的RVI相关，儿童尤其易患RVI。试验注册 临床试验标识符：NCT0418467。
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