Validation of at-the-bedside formulae for estimating ventilator driving pressure during airway pressure release ventilation using computer simulation.
Validation of at-the-bedside formulae for estimating ventilator driving pressure during airway pressure release ventilation using computer simulation.
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DOI：
10.1186/s12931-022-01985-z
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发表时间：
2022-04-26
影响因子：
5.8
通讯作者：
中科院分区：
文献类型：
--
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气道压力释放通气（APRV）广泛应用于机械呼吸机上，并已被提议作为预防肺损伤的早期干预措施或作为治疗难治性低氧血症的抢救疗法。大量研究已将驱动压 () 确定为呼吸机引起的肺损伤的关键指标，需要仔细控制。 呼吸机提供的 APRV 在动态条件下无法直接测量，并且没有“黄金标准”方法进行估算。我们使用与 90 名急性呼吸窘迫综合征 (ARDS) 患者的数据相匹配的计算模拟器来评估三种“床边”方法在 APRV 期间估计呼吸机的准确性。 APRV 中呼吸机输送的水平通常在安全范围内，但在某些情况下超出了保护性通气策略规定的水平。基于估计 APRV 释放结束时存在的固有呼气末正压的公式提供了最准确的估计。第二个公式基于假设呼气流量、容量和压力单指数衰减，第三个方法需要暂时切换到容量控制通气，也提供了真实的准确估计。 APRV 期间呼吸机输送的水平可能会超过标准保护性通气策略规定的水平，这凸显了仔细监测的必要性。我们的结果表明，可以在床边使用基于现成测量值的简单公式来准确估计呼吸机在 APRV 期间提供的流量。在线版本包含可在 10.1186/s12931-022-01985-z 获取的补充材料。
Airway pressure release ventilation (APRV) is widely available on mechanical ventilators and has been proposed as an early intervention to prevent lung injury or as a rescue therapy in the management of refractory hypoxemia. Driving pressure () has been identified in numerous studies as a key indicator of ventilator-induced-lung-injury that needs to be carefully controlled. delivered by the ventilator in APRV is not directly measurable in dynamic conditions, and there is no “gold standard” method for its estimation. We used a computational simulator matched to data from 90 patients with acute respiratory distress syndrome (ARDS) to evaluate the accuracy of three “at-the-bedside” methods for estimating ventilator during APRV. Levels of delivered by the ventilator in APRV were generally within safe limits, but in some cases exceeded levels specified by protective ventilation strategies. A formula based on estimating the intrinsic positive end expiratory pressure present at the end of the APRV release provided the most accurate estimates of . A second formula based on assuming that expiratory flow, volume and pressure decay mono-exponentially, and a third method that requires temporarily switching to volume-controlled ventilation, also provided accurate estimates of true . Levels of delivered by the ventilator during APRV can potentially exceed levels specified by standard protective ventilation strategies, highlighting the need for careful monitoring. Our results show that delivered by the ventilator during APRV can be accurately estimated at the bedside using simple formulae that are based on readily available measurements. The online version contains supplementary material available at 10.1186/s12931-022-01985-z.
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影响因子：
9.8
作者：
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通讯作者：
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