A comparison of methods to identify open-lung PEEP.
A comparison of methods to identify open-lung PEEP.
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DOI：
10.1007/s00134-009-1412-9
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发表时间：
2009-04
影响因子：
38.9
通讯作者：
Harris, R. Scott
中科院分区：
文献类型：
--
作者：
Caramez, Maria Paula;Kacmarek, Robert M.;Helmy, Mohamed;Miyoshi, Eriko;Malhotra, Atul;Amato, Marcelo B. P.;Harris, R. Scott
文献中存在许多方法来确定 ARDS 患者在肺复张操作 (RM) 后设置的 PEEP。我们比较了 RM 后设置 PEEP 的 10 个已发布参数。通过对 14 只雌性多赛特羊进行双侧肺灌洗诱导肺损伤，在 FIO2 1.0 和 PEEP 5 cmH2O 下产生 PaO2 100-150 mmHg。然后使用超级注射器方法绘制准静态 P-V 曲线； PEEP 设置为 20 cmH2O，并通过压力控制通气进行 RM（吸气压力设置为 40–50 cmH2O），直到 PaO2 + PaCO2 > 400 mmHg。 RM 后，进行了递减 PEEP 试验。 PEEP 每 5 分钟以 1 cmH2O 的幅度降低，直至达到 15 cmH2O。将递减 PEEP 试验期间测量的参数与从 P-V 曲线获得的参数进行比较。对于设置 PEEP，最大动态潮气呼吸顺应性、最大 PaO2、最大 PaO2 + PaCO2 和递减 PEEP 试验期间计算的最小分流，以及 P-V 曲线充气肢 (Pmci,i) 上的较低 Pflex 和最大顺应性增加点在统计上无法区分。使用通气上 Pflex 和通气肢体最大顺应性下降点获得的 PEEP 值显着较高，而通气肢体上的真实拐点和最低 PaCO2 显着低于其他变量。在该 ARDS 动物模型中，动态潮气呼吸顺应性、最大 PaO2、最大 PaO2 + PaCO2、最小分流、充气较低 Pflex 和 Pmci,i 在肺复张操作后产生相似的 PEEP 值。
Many methods exist in the literature for identifying PEEP to set in ARDS patients following a lung recruitment maneuver (RM). We compared ten published parameters for setting PEEP following a RM. Lung injury was induced by bilateral lung lavage in 14 female Dorset sheep, yielding a PaO2 100–150 mmHg at FIO2 1.0 and PEEP 5 cmH2O. A quasi-static P–V curve was then performed using the supersyringe method; PEEP was set to 20 cmH2O and a RM performed with pressure control ventilation (inspiratory pressure set to 40–50 cmH2O), until PaO2 + PaCO2 > 400 mmHg. Following the RM, a decremental PEEP trial was performed. The PEEP was decreased in 1 cmH2O steps every 5 min until 15 cmH2O was reached. Parameters measured during the decremental PEEP trial were compared with parameters obtained from the P–V curve. For setting PEEP, maximum dynamic tidal respiratory compliance, maximum PaO2, maximum PaO2 + PaCO2, and minimum shunt calculated during the decremental PEEP trial, and the lower Pflex and point of maximal compliance increase on the inflation limb of the P–V curve (Pmci,i) were statistically indistinguishable. The PEEP value obtained using the deflation upper Pflex and the point of maximal compliance decrease on the deflation limb were significantly higher, and the true inflection point on the inflation limb and minimum PaCO2 were significantly lower than the other variables. In this animal model of ARDS, dynamic tidal respiratory compliance, maximum PaO2, maximum PaO2 + PaCO2, minimum shunt, inflation lower Pflex and Pmci,i yield similar values for PEEP following a recruitment maneuver.
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影响因子：
5.7
作者：
Ranieri, VM;Grasso, S;Giuliani, R
通讯作者：
Giuliani, R
影响因子：
158.5
作者：
Amato, MBP;Barbas, CSV;Carvalho, CRR
通讯作者：
Carvalho, CRR
DOI：
10.1164/ajrccm.149.5.8173774
发表时间：
1994-05-01
影响因子：
24.7
作者：
MUSCEDERE, JG;MULLEN, JBM;SLUTSKY, AS
通讯作者：
SLUTSKY, AS
影响因子：
8.8
作者：
通讯作者：
--
影响因子：
8.8
作者：
BOND, DM;FROESE, AB
通讯作者：
FROESE, AB