Rudolph Michelle W, Sietses Maaike, Koopman Alette A, Blokpoel Robert G T, Kneyber Martin C J
Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Critical Care, Anaesthesiology, Peri-operative and Emergency Medicine (CAPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Pediatr Crit Care Med. 2025 Apr 1;26(4):e498-e506. doi: 10.1097/PCC.0000000000003697. Epub 2025 Feb 13.
To compare the level of agreement between proximal (near the subject) and distal (inside the ventilator) measured airway occlusion pressure at 100 ms (P0.1) and occlusion pressure (Δ Pocc ), and to study the correlation between Δ Pocc and peak-to-trough esophageal pressure (Δ Pes ).
Secondary analysis of prospectively collected physiology dataset (2021-2022).
Medical-surgical 20-bed PICU.
Children younger than 18 years with and without acute lung injury ventilated greater than 24 hours and spontaneously breathing with appropriate triggering of the ventilator.
None.
Data from three expiratory hold maneuvers (with a maximum of three breaths during each maneuver) in 74 subjects (118 measurements) with median age 3 months (interquartile range 1-17), and primary respiratory failure due to a pulmonary infection in 41/74 (55.4%) were studied. The median proximal ∆ Pocc was 6.7 cm H 2 O (3.1-10.7) and median P0.1 4.9 cm H 2 O (4.1-6.0) for the first breath from the maneuver; both increased significantly ( p < 0.001) with the subsequent two breaths during the same maneuver. Median distal ∆ Pocc was 6.8 (2.9-10.8) and P0.1 4.6 (3.9-5.6) cm H 2 O; both increased significantly ( p < 0.001) with the two subsequent breaths. Proximal and distal Δ Pocc ( r > 0.99, p < 0.001) and P0.1 ( r > 0.80, p < 0.001) were correlated. Correlation between ventilator displayed and Y-piece measured Δ Pocc ( r > 0.99) and P0.1 ( r = 0.85) was good. Mean ( sd ) difference for Δ Pocc was 0.13 (0.21); levels of agreement were -0.28 and 0.54. For P0.1, mean ( sd ) difference was -0.36 (1.14) and levels of agreement -2.61 and 1.88. There was a high correlation between Δ Pes and ∆ Pocc ( r = 0.92) for the same breath and a good correlation with Δ Pes from the preceding breath ( r = 0.76). There was a poor correlation with the transpulmonary pressure ( r = 0.37).
Δ Pocc is not affected by measurement site, whereas P0.1 may be overestimated or underestimated. Δ Pocc was highly correlated with the peak-to-trough esophageal pressure, supporting the concept that inspiratory effort can also be quantified noninvasively by measuring Δ Pocc .
比较在100毫秒时近端（靠近受试者）和远端（呼吸机内部）测量的气道闭塞压（P0.1）与闭塞压（ΔPocc）之间的一致性水平，并研究ΔPocc与峰谷食管压（ΔPes）之间的相关性。
对前瞻性收集的生理学数据集（2021 - 2022年）进行二次分析。
拥有20张床位的内科 - 外科重症监护病房。
年龄小于18岁、有或无急性肺损伤且机械通气超过24小时、在呼吸机适当触发下自主呼吸的儿童。
无。
研究了74名受试者（118次测量）的三次呼气末屏气操作（每次操作最多三次呼吸）的数据，这些受试者的中位年龄为3个月（四分位间距1 - 17），41/74（55.4%）因肺部感染导致原发性呼吸衰竭。操作中第一次呼吸的近端ΔPocc中位数为6.7 cmH₂O（3.1 - 10.7），P0.1中位数为4.9 cmH₂O（4.1 - 6.0）；在同一次操作的后续两次呼吸中均显著增加（p < 0.001）。远端ΔPocc中位数为6.8（2.9 - 10.8），P0.1为4.6（3.9 - 5.6）cmH₂O；在后续两次呼吸中均显著增加（p < 0.001）。近端和远端的ΔPocc（r > 0.99，p < 0.001）和P0.1（r > 0.80，p < 0.001）具有相关性。呼吸机显示的与Y形管测量的ΔPocc（r > 0.99）和P0.1（r = 0.85）相关性良好。ΔPocc的平均（标准差）差异为0.13（0.21）；一致性水平为 - 0.28和0.54。对于P0.1，平均（标准差）差异为 - 0.36（1.14），一致性水平为 - 2.61和1.88。同一次呼吸的ΔPes与ΔPocc之间存在高度相关性（r = 0.92），与前一次呼吸的ΔPes相关性良好（r = 0.76）。与跨肺压的相关性较差（r = 0.37）。
ΔPocc不受测量部位影响，而P0.1可能被高估或低估。ΔPocc与峰谷食管压高度相关，支持通过测量ΔPocc也可无创量化吸气努力的概念。
