有创胸膜测压法探究腹部加压时矛盾顺应性反应背后的生理机制——急性呼吸窘迫综合征中“不可扩张”肺的一例报告
Invasive Pleural Manometry to Explore the Physiology Behind Paradoxical Compliance Response to Abdominal Compression-A Case of "Unexpandable" Lung in Acute Respiratory Distress Syndrome.
作者信息
Martel-Pelletier Charles-Étienne, Laufer Brian, Brosseau Marc, Viau-Lapointe Julien, Tremblay Jan-Alexis
机构信息
Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
Service de soins intensifs, Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada.
出版信息
Crit Care Explor. 2025 Apr 22;7(4):e1260. doi: 10.1097/CCE.0000000000001260. eCollection 2025 Apr 1.
BACKGROUND
Recent reports have described an intriguing pathophysiological phenomenon in acute respiratory distress syndrome (ARDS), with the paradoxical improvement of respiratory mechanics after maneuvers raising intra-abdominal pressure in the context of low positive end-expiratory pressure.
CASE SUMMARY
We hereby present a case exhibiting this paradoxical physiology during mechanical ventilation for severe COVID-19-associated ARDS and discuss the findings of our physiologic assessment of this condition with invasive pleural manometry performed at the bedside.
CONCLUSIONS
Even though it is rare, awareness of this intriguing condition is paramount to the critical care physician as the lung mechanics of these patients can deteriorate with traditional treatment strategies.
背景
最近的报告描述了急性呼吸窘迫综合征（ARDS）中一种有趣的病理生理现象，即在呼气末正压较低的情况下，增加腹内压的操作后呼吸力学反而出现矛盾性改善。
病例摘要
我们在此呈现一例在重症新型冠状病毒肺炎相关ARDS机械通气期间出现这种矛盾性生理现象的病例，并讨论通过床旁有创胸膜测压对该病情进行生理评估的结果。
结论
尽管这种情况罕见，但对于重症监护医生而言，认识到这种有趣的病情至关重要，因为这些患者的肺力学可能会因传统治疗策略而恶化。
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