MEAN AIRWAY PRESSURE - PHYSIOLOGICAL DETERMINANTS AND CLINICAL IMPORTANCE .1. PHYSIOLOGICAL DETERMINANTS AND MEASUREMENTS
MEAN AIRWAY PRESSURE - PHYSIOLOGICAL DETERMINANTS AND CLINICAL IMPORTANCE .1. PHYSIOLOGICAL DETERMINANTS AND MEASUREMENTS
复制标题
DOI：
10.1097/00003246-199210000-00017
复制
发表时间：
1992-10-01
影响因子：
8.8
通讯作者：
RAVENSCRAFT, SA
中科院分区：
文献类型：
--
作者：
MARINI, JJ;RAVENSCRAFT, SA
用途：讨论平均肺泡压与其最容易测量的模拟物平均气道压的理论关系，并描述该指数的关键决定因素、测量考虑因素和临床意义。数据来源：来自医学和生理学文献的相关文章，以及本文从第一原理发展的数学论证。研究选择：阐述平均气道压的生理重要性、测量或不良后果的理论、实验和临床信息。数据提取：数学模型与已发表文献的数据结合使用，以统一描述平均气道的生理和临床相关性pressure.Synthesis.几何和数学分析表明，共享的元素包括平均气道压力和平均肺泡压力，这两个变量通过以下公式相关：平均肺泡压力=平均气道压力+（VE/60）x（RE-RI），其中VE、RE和RI分别是每分钟通气量以及呼气和吸气阻力。可以制定明确的指南，用于选择平均气道压力测定的部位，用于指定平均气道压力测量的技术要求，以及用于描绘调整平均气道压力水平的临床选择。将平均气道压力视为平均肺泡压力的反映的问题可以根据它们相互关系的理论基础来解释。在某些情况下，平均气道压与通气水平、动脉氧合、心血管功能和气压伤密切相关。由于平均气道压力是与有益的和不利的影响，其理论和实践基础的透彻理解是不可或缺的，制定一个有效的压力为目标的策略的呼吸support.Conclusions：平均气道压力密切反映平均肺泡压，除了当流动阻力的压力损失差异很大的吸气和呼气阶段的呼吸周期。在被动充气条件下，平均气道压与肺泡通气、动脉氧合、血流动力学表现和气压伤相关。我们鼓励更广泛地使用这一指数，适当地衡量和解释，以及它的纳入合理的战略，为危重病的解释性管理。
Purposes: To discuss the theoretical relationship of mean alveolar pressure to its most easily measured analog, the mean airway pressure, and to describe the key determinants, measurement considerations, and clinical implications of this index.Data Sources: Relevant articles from the medical and physiologic literature, as well as mathematical arguments developed in this article from first principles.Study Selection: Theoretical, experimental, and clinical information that elucidates the physiologic importance, measurement, or adverse consequences of mean airway pressure.Data Extraction: Mathematical models were used in conjunction with data from the published literature to develop a unified description of the physiological and clinical relevance of mean airway pressure.Synthesis. Geometrical and mathematical analyses demonstrate that shared elements comprise mean airway pressure and mean alveolar pressure, two variables that are related by the formula: mean alveolar pressure = mean airway pressure + (VE/60) x (RE - RI), where VE, RE, and RI are minute ventilation and expiratory and inspiratory resistances, respectively. Clear guidelines can be developed for selecting the site of mean airway pressure determination, for specifying technical requirements for mean airway pressure measurement, and for delineating clinical options to adjust the level of mean airway pressure. Problems in viewing mean airway pressure as a reflection of mean alveolar pressure can be interpreted against the theoretical basis of their interrelationship. In certain settings, mean airway pressure closely relates to levels of ventilation, arterial oxygenation, cardiovascular function, and barotrauma. Because mean airway pressure is associated with both beneficial and adverse effects, a thorough understanding of its theoretical and practical basis is integral to formulating an effective pressure-targeted strategy of ventilatory support.Conclusions: Mean airway pressure closely reflects mean alveolar pressure, except when flow-resistive pressure losses differ greatly for the inspiratory and expiratory phases of the ventilatory cycle. Under conditions of passive inflation, mean airway pressure correlates with alveolar ventilation, arterial oxygenation, hemodynamic performance, and barotrauma. We encourage wider use of this index, appropriately measured and interpreted, as well as its incorporation into rational strategies for the ventilatory management of critical illness.