呼吸机所致肺损伤风险的预测指标：驱动压、4DPRR与机械功率比——一项实验研究

Predictors of VILI risk: driving pressure, 4DPRR and mechanical power ratio-an experimental study.

作者信息

Galizia Mauro, Ghidoni Valentina, Catozzi Giulia, Giovanazzi Stefano, Nocera Domenico, Donati Beatrice, Pozzi Tommaso, D'Albo Rosanna, Busana Mattia, Romitti Federica, Herrmann Peter, Moerer Onnen, Meissner Konrad, Quintel Michael, Camporota Luigi, Gattinoni Luciano

机构信息

Department of Anaesthesiology, University Medical Center Göttingen, Robert-Koch-Straβe 40, 37075, Göttingen, Germany.

Department of Health Sciences, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italia.

出版信息

Intensive Care Med Exp. 2024 Dec 11;12(1):116. doi: 10.1186/s40635-024-00697-6.

DOI:10.1186/s40635-024-00697-6

PMID:39661304

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11635077/

Abstract

BACKGROUND

Ventilator-induced lung injury (VILI) is one of the side effects of mechanical ventilation during ARDS; a prerequisite for averting it is the quantification of its risk factors associated with a given ventilatory setting. Many clinical variables have been proposed as predictors of VILI, of which driving pressure is the most widely used. In this study, we compared the performance of driving pressure, four times the driving pressure added to respiratory rate (4DPRR) and mechanical power ratio.

RESULTS

In a study population of 121 previously healthy pigs exposed to harmful ventilation, we compared the association of driving pressure, 4DPRR and mechanical power ratio to lung weight, lung wet-to-dry and total histological score. All the three variables were associated with these outcomes. Driving pressure, 4DPRR and mechanical power ratio increase linearly with the lung weight (adjusted R of 0.27, 0.36 and 0.40, respectively), the lung wet-to-dry ratio (adjusted R of 0.19, 0.25 and 0.37) and the total histological score (adjusted R of 0.26, 0.38 and 0.26). Using a multiple linear regression model with forward analysis, starting with tidal volume and progressively adding respiratory rate and positive end-expiratory pressure, and comparing the topic with the outcome variables, we obtained R values, respectively, of 0.07, 0.20, 0.42 for lung weight, 0.09, 0.19, 0.26 for lung wet-to-dry ratio and 0.07, 0.27, 0.43 for total histological score.

CONCLUSIONS

Driving pressure, 4DPRR and mechanical power ratio, were all associated with lung injury in healthy animals undergoing mechanical ventilation.

摘要

背景

呼吸机诱导的肺损伤（VILI）是急性呼吸窘迫综合征（ARDS）机械通气期间的副作用之一；避免VILI的一个先决条件是对与特定通气设置相关的风险因素进行量化。许多临床变量已被提出作为VILI的预测指标，其中驱动压是使用最广泛的。在本研究中，我们比较了驱动压、四倍驱动压加呼吸频率（4DPRR）和机械功率比的性能。

结果

在121只先前健康的猪暴露于有害通气的研究群体中，我们比较了驱动压、4DPRR和机械功率比与肺重量、肺湿干比和总组织学评分的相关性。所有这三个变量均与这些结果相关。驱动压、4DPRR和机械功率比与肺重量（调整后的R分别为0.27、0.36和0.40）、肺湿干比（调整后的R为0.19、0.25和0.37）和总组织学评分（调整后的R为0.26、0.38和0.26）呈线性增加。使用具有向前分析的多元线性回归模型，从潮气量开始，逐步添加呼吸频率和呼气末正压，并将该主题与结果变量进行比较，我们分别获得了肺重量的R值为0.07、0.20、0.42，肺湿干比的R值为0.09、0.19、0.26，总组织学评分的R值为0.07、0.27、0.43。