Why Reduced Inspiratory Pressure Could Determine Success of Non-Invasive Ventilation in Acute Hypoxic Respiratory Failure.
Why Reduced Inspiratory Pressure Could Determine Success of Non-Invasive Ventilation in Acute Hypoxic Respiratory Failure.
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为什么降低吸气压可以决定急性缺氧性呼吸衰竭无创通气的成功。
DOI：
10.1109/embc48229.2022.9871901
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Weaver L
中科院分区：
文献类型：
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作者：
Weaver L
在最近的一项探索性临床研究中，缺氧性呼吸衰竭无创通气前2小时内的吸气努力缓解程度是24小时结局的早期准确预测因子。我们模拟了无创通气在三名患者中的应用，这些患者的生理和临床特征与该研究中的数据相匹配。与食管压力摆动大于10 cmH 2 O的减少相对应的吸气努力的减少使总肺应力、驱动压力、功率和经尿道压力摆动的值减少一半以上。在吸气压没有显著降低的情况下，应用无创通气后，肺损伤的多个指标增加。临床相关性-我们使用计算机模拟表明，应用无创通气后降低的吸气压直接转化为多个公认的肺损伤指标的大幅降低，为最近的临床发现提供了潜在的生理学解释。
The magnitude of inspiratory effort relief within the first 2 hours of non-invasive ventilation for hypoxic respiratory failure was shown in a recent exploratory clinical study to be an early and accurate predictor of outcome at 24 hours. We simulated the application of non-invasive ventilation to three patients whose physiological and clinical characteristics match the data in that study. Reductions in inspiratory effort corresponding to reductions of esophageal pressure swing greater than 10 cmH2O more than halved the values of total lung stress, driving pressure, power and transpulmonary pressure swing. In the absence of significant reductions in inspiratory pressure, multiple indicators of lung injury increased after application of non-invasive ventilation. Clinical Relevance- We show using computer simulation that reduced inspiratory pressure after application of noninvasive ventilation translates directly into large reductions in multiple well-established indicators of lung injury, providing a potential physiological explanation for recent clinical findings.