Esophageal and transpulmonary pressures in acute respiratory failure
Esophageal and transpulmonary pressures in acute respiratory failure
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DOI：
10.1097/01.ccm.0000215515.49001.a2
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发表时间：
2006-05-01
影响因子：
8.8
通讯作者：
Loring, SH
中科院分区：
文献类型：
--
作者：
Talmor, D;Sarge, T;Loring, SH
目的：在机械通气期间使肺膨胀的压力是在气道开口处施加的压力（P-ao）与胸膜压力（P-pi）之间的差。取决于胸壁对呼吸力学的贡献，给定的呼气末和/或吸气末正压平台压力可能适合于一个患者，但对于另一个患者是不充分的或可能有害的。因此，未能解释胸壁力学可能会影响急性呼吸窘迫综合征机械通气策略的临床试验结果。通过测量食管压力（P-es），我们试图描述急性呼吸衰竭患者胸壁对P-pI和经食管压力（P-L）的影响。设计：前瞻性观察研究。贝丝以色列女执事医疗中心的内科和外科重症监护室。患者：70名急性呼吸衰竭患者。食管球囊导管的放置：测量和主要结果：呼气末和充气末记录的气道、食管和胃压力，呼气末P-es平均为17.5 +/- 5.7 cm H2O，充气末P-es平均为21.2 +/- 7.7 cm H2O，与体重指数或胸壁弹性无显著相关性。呼气末时的P-L估计值为1.5 +/- 6.3 cm H2O，充气末时为21.4 +/- 9.3 cm H2O，吸气末保持（平台期）期间为18.4 +/- 10.2 cm H2O（n = 40）。虽然呼气末P-L与呼气末正压显著相关（p
Objective: Pressure inflating the lung during mechanical ventilation is the difference between pressure applied at the airway opening (P-ao) and pleural pressure (P-pi). Depending on the chest wall's contribution to respiratory mechanics, a given positive end-expiratory and/or end-inspiratory plateau pressure may be appropriate for one patient but inadequate or potentially injurious for another. Thus, failure to account for chest wall mechanics may affect results in clinical trials of mechanical ventilation strategies in acute respiratory distress syndrome. By measuring esophageal pressure (P-es) we sought to characterize influence of the chest wall on P-pI and transpulmonary pressure (P-L) in patients with acute respiratory failure.Design: Prospective observational study.Setting. Medical and surgical intensive care units at Beth Israel Deaconess Medical Center.Patients: Seventy patients with acute respiratory failure.Interventions. Placement of esophageal balloon-catheters.Measurements and Main Results: Airway, esophageal, and gastric pressures recorded at end-exhalation and end-inflation P-es averaged 17.5 +/- 5.7 cm H2O at end-expiration and 21.2 +/- 7.7 cm H2O at end-inflation and were not significantly correlated with body mass index or chest wall elastance. Estimated P-L was 1.5 +/- 6.3 cm H2O at end-expiration, 21.4 +/- 9.3 cm H2O at end-inflation, and 18.4 +/- 10.2 cm H2O (n = 40) during an end-inspiratory hold (plateau). Although P-L at end-expiration was significantly correlated with positive end-expiratory pressure (p