Recruitment and derecruitment during acute respiratory failure - A clinical study
Recruitment and derecruitment during acute respiratory failure - A clinical study
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DOI：
10.1164/ajrccm.164.1.2007011
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发表时间：
2001-07-01
影响因子：
24.7
通讯作者：
Gattinoni, L
中科院分区：
文献类型：
--
作者：
Crotti, S;Mascheroni, D;Gattinoni, L
在急性肺损伤模型中，我们发现呼气末正压（PEEP）和潮气量（VT）是决定肺复张程度的交互变量，肺复张发生在整个肺容量范围内，并且叠加压力是肺塌陷的关键决定因素。为了验证相同的规则是否适用于临床环境，我们随机对 5 名 ALI/ARDS 患者进行通气，平台压为 10、15、20、30、35 和 45 cm H2O，PEEP 为 5、10、15 和 20 cm H2O。对于每个 PEEP-VT 条件，我们在吸气末和呼气末获得了计算机断层扫描。我们发现，募集发生在整个容量-压力曲线上，与下拐点和上拐点无关，并且估计的阈值开放压力呈正态分布（众数 = 20 cm H2O）。从非依赖性肺区域到依赖性肺区域逐渐进行募集。过度拉伸与恶性通货膨胀无关。收缩并不平行于通货紧缩，估计的阈值关闭压力呈正态分布（众数 = 5 cm H2O）。吸气末和呼气末塌陷是相关的，表明平台期-PEEP 相互作用。当叠加重力压力超过 PEEP 时，呼气末塌陷增加。我们得出的结论是，招募和终止招募的规则同样适用于油酸模型和人类 ALI/ARDS。
In a model of acute lung injury, we showed that positive end-expiratory pressure (PEEP) and tidal volume (VT) are interactive variables that determine the extent of lung recruitment, that recruitment occurs across the entire range of total lung capacity, and that superimposed pressure is a key determinant of lung collapse. Aiming to verify if the same rules apply in a clinical setting, we randomly ventilated five ALI/ARDS patients with 10, 15, 20, 30, 35, and 45 cm H2O plateau pressure and 5, 10, 15, and 20 cm H2O of PEEP. For each PEEP-VT condition, we obtained computed tomography at end inspiration and end expiration. We found that recruitment occurred along the entire volume-pressure curve, independent of lower and upper inflection points, and that estimated threshold opening pressures were normally distributed (mode = 20 cm H2O). Recruitment occurred progressively from nondependent to dependent lung regions. Overstretching was not associated with hyperinflation. Derecruitment did not parallel deflation, and estimated threshold closing pressures were normally distributed (mode = 5 cm H2O). End-inspiratory and end-expiratory collapse were correlated, suggesting a plateau-PEEP interaction. When superimposed gravitational pressure exceeded PEEP, end-expiratory collapse increased. We concluded that the rules governing recruitment and derecruitment equally apply in an oleic acid model and in human ALI/ARDS.