Estimation of inspiratory effort using airway occlusion maneuvers in ventilated children: a secondary analysis of an ongoing randomized trial testing a lung and diaphragm protective ventilation strategy.
Estimation of inspiratory effort using airway occlusion maneuvers in ventilated children: a secondary analysis of an ongoing randomized trial testing a lung and diaphragm protective ventilation strategy.
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DOI：
10.1186/s13054-023-04754-6
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发表时间：
2023-11-29
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监测通气患者的呼吸努力对于平衡肺和膈肌保护非常重要。食管测压仍然是监测呼吸努力的金标准，但具有侵入性，需要专业知识进行测量和解释。尽管儿科数据有限，但阻塞操作期间的气道压力可能提供一种替代方法。我们试图确定潮气呼吸期间食管压力变化（PIPes）与三种气道阻塞操作期间测量的气道压力之间的相关性：（1）呼气阻塞压力（Pocc），（2）气道阻塞压力（P0.1）和（3）儿童呼吸肌压力指数（PMI）。我们还试图探索这些压力的儿科阈值，以检测过度或不足的呼吸努力。对1个月至18岁急性呼吸窘迫综合征儿童的生理数据进行二次分析，这些儿童入组了一项正在进行的随机临床试验，该试验测试了肺和膈肌保护性通气策略（REDvent，R 01 HL 124666）。测量P0.1、P0.1和PMI。重复测量相关性被用来调查的相关系数之间的相关系数，三个措施，和线性回归方程，以确定潜在的治疗阈值。97例患者共进行了653次吸气暂停和713次呼气暂停。Pocc与PMI-Pes的相关性最强（r = 0.68），其次是PMI（r = 0.60）和P0.1（r = 0.42）。可以使用回归方程Pocc = 0.66 Pocc（R2 = 0.82）可靠地估计Pocc，Pocc临界点具有高特异性和中等灵敏度，以检测高和低呼吸努力的相应Pocc阈值。基于年龄（婴儿、儿童、青少年）或通气模式（SIMV与压力支持）的Pocc和CMPes之间的关系差异极小，尽管这些差异在P0.1和PMI中更为明显。气道阻塞操作可能是食管压力测量的适当替代方案，以估计儿童的吸气努力，Pocc是最有前途的目标。试验注册：NCT 03266016; 2017年8月23日。在线版本包含补充材料，可通过10.1186/s13054-023-04754-6获得。
Monitoring respiratory effort in ventilated patients is important to balance lung and diaphragm protection. Esophageal manometry remains the gold standard for monitoring respiratory effort but is invasive and requires expertise for its measurement and interpretation. Airway pressures during occlusion maneuvers may provide an alternative, although pediatric data are limited. We sought to determine the correlation between change in esophageal pressure during tidal breathing (∆Pes) and airway pressure measured during three airway occlusion maneuvers: (1) expiratory occlusion pressure (Pocc), (2) airway occlusion pressure (P0.1), and (3) respiratory muscle pressure index (PMI) in children. We also sought to explore pediatric threshold values for these pressures to detect excessive or insufficient respiratory effort. Secondary analysis of physiologic data from children between 1 month and 18 years of age with acute respiratory distress syndrome enrolled in an ongoing randomized clinical trial testing a lung and diaphragm protective ventilation strategy (REDvent, R01HL124666). ∆Pes, Pocc, P0.1, and PMI were measured. Repeated measure correlations were used to investigate correlation coefficients between ∆Pes and the three measures, and linear regression equations were generated to identify potential therapeutic thresholds. There were 653 inspiratory and 713 expiratory holds from 97 patients. Pocc had the strongest correlation with ∆Pes (r = 0.68), followed by PMI (r = 0.60) and P0.1 (r = 0.42). ∆Pes could be reliably estimated using the regression equation ∆Pes = 0.66 Pocc (R2 = 0.82), with Pocc cut-points having high specificity and moderate sensitivity to detect respective ∆Pes thresholds for high and low respiratory effort. There were minimal differences in the relationship between Pocc and ∆Pes based on age (infant, child, adolescent) or mode of ventilation (SIMV versus Pressure Support), although these differences were more apparent with P0.1 and PMI. Airway occlusion maneuvers may be appropriate alternatives to esophageal pressure measurement to estimate the inspiratory effort in children, and Pocc represents the most promising target. Trial registration: NCT03266016; August 23, 2017. The online version contains supplementary material available at 10.1186/s13054-023-04754-6.
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影响因子：
8.8
作者：
Kyogoku M;Shimatani T;Hotz JC;Newth CJL;Bellani G;Takeuchi M;Khemani RG
通讯作者：
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DOI：
10.1164/rccm.201312-2193ci
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DOI：
10.1164/rccm.201703-0536oc
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影响因子：
24.7
作者：
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通讯作者：
Ferguson, Niall D.
DOI：
10.1164/rccm.201605-1081cp
发表时间：
2017-02-15
影响因子：
24.7
作者：
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通讯作者：
Pesenti, Antonio
DOI：
10.1164/rccm.202003-0655cp
发表时间：
2020-10-01
影响因子：
24.7
作者：
Goligher, Ewan C.;Dres, Martin;Brochard, Laurent
通讯作者：
Brochard, Laurent