Sine ventilation in lung injury models: a new perspective for lung protective ventilation
Sine ventilation in lung injury models: a new perspective for lung protective ventilation
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肺损伤模型中的正弦通气：肺保护性通气的新视角
DOI：
10.1038/s41598-020-68614-x
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发表时间：
2020
影响因子：
4.6
通讯作者：
Schumann S
中科院分区：
文献类型：
--
作者：
Spassov S;Wenzel C;Lozano-Zahonero S;Boycheva D;Streicher L;Schmidt J;Schumann S
机械通气与呼吸机诱导的肺损伤的风险相关。为了减少机械通气患者的肺损伤，应用小潮气量和呼气末正压已成为临床标准。最近，一种基于线性气道压力下降和呼气流速减慢的方法暗示了肺保护能力。我们假设具有平滑的（即正弦的）气道压力分布的通气可以进一步改善通气效率和肺保护。我们在两种大鼠肺损伤模型中比较了正弦气道压力曲线（SINE）机械通气与常规容量和压力控制通气（VCV和PCV）以及流量控制呼气（FLEX）VCV在气体交换、呼吸系统顺应性和组织学方面的作用，吐温诱导的表面活性剂耗竭和高潮气量机械通气。在两种肺损伤模型中，与VCV、PCV和FLEX相比，SINE通气显示出更有效的CO2清除和血氧合，改善呼吸系统顺应性，并导致更低的肺泡壁厚度。气道压力分布的优化可以提供肺保护性机械通气的新手段。
Mechanical ventilation is associated with the risk of ventilator induced lung injury. For reducing lung injury in mechanically ventilated patients, the application of small tidal volumes and positive end-expiratory pressures has become clinical standard. Recently, an approach based on linear airway pressure decline and decelerated expiratory flow during expiration implied lung protective capacities. We assumed that ventilation with a smoothed, i.e. sinusoidal airway pressure profile may further improve ventilation efficiency and lung protection. We compared the effects of mechanical ventilation with sinusoidal airway pressure profile (SINE) regarding gas exchange, respiratory system compliance and histology to conventional volume and pressure controlled ventilation (VCV and PCV) and to VCV with flow-controlled expiration (FLEX) in two rat models of lung injury, tween induced surfactant depletion and high tidal volume mechanical ventilation. In both lung injury models ventilation with SINE showed more efficient CO2elimination and blood oxygenation, improved respiratory system compliance and resulted in lower alveolar wall thickness, compared to VCV, PCV and FLEX. Optimization of the airway pressure profile may provide a novel means of lung protective mechanical ventilation.
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