Direction and Magnitude of Change in Plateau From Peak Pressure During Inspiratory Holds Can Identify the Degree of Spontaneous Effort and Elastic Workload in Ventilated Patients.
Direction and Magnitude of Change in Plateau From Peak Pressure During Inspiratory Holds Can Identify the Degree of Spontaneous Effort and Elastic Workload in Ventilated Patients.
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DOI：
10.1097/ccm.0000000000004746
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发表时间：
2021-03-01
影响因子：
8.8
通讯作者：
Khemani RG
中科院分区：
文献类型：
--
作者：
Kyogoku M;Shimatani T;Hotz JC;Newth CJL;Bellani G;Takeuchi M;Khemani RG
通过测量气道压力来估计驱动压力（弹性功）的吸气屏气通常仅限于没有呼吸努力的患者。我们试图评估吸气屏气期间的气道压力测量是否可用于机械通气期间自主呼吸努力的患者，以估计自主呼吸努力和弹性功的程度。我们通过对 PARDS 儿童的生理数据进行二次分析，比较了吸气屏气期间气道压力与食管压力的变化方向和程度，这些儿童在压力控制或压力支持通气时有自主呼吸的证据。儿童是从洛杉矶儿童医院的重症监护室入组的。根据气道压力，我们将“平台-峰值压力”定义为 PMI，将其分为三类进行分析（< -1（“阴性”）、介于 -1 和 1（“中性”）和 > 1 cmH2O（“阳性”））。纳入了 65 个研究日的 30 名儿童（年龄 36.8 (16.1–70.3) 个月），其中包括 118 次吸气屏气。PMI 在 29 次中为“阴性”。 17 例为“中性”，72 例为“阳性”。随着 PMI 从负值变为中性值再变为正值，食管压力分别出现较大的负偏转 -5.0 (-8.2-1.9)、-5.9 (-7.6-4.3) 和 -10.7 (-18.1-7.9) cmH2O (p < 0.0001)。最大食管负压与 PMI 之间存在相关性（r = −0.52），当 PMI ≥ 7 cmH2O 时，最大食管负压 >10 cmH2O。 PMI 与食管压力的弹性功标记之间存在更强的相关性（r = 0.84）。吸气屏气期间平台减去峰值压力的大小与吸气努力的程度相关，特别是对于那些具有高弹性功的患者。识别过度努力或高驾驶压力的患者。
Inspiratory holds with measures of airway pressure to estimate driving pressure (elastic work) are often limited to patients without respiratory effort. We sought to evaluate if measures of airway pressure during inspiratory holds could be used for patients with spontaneous respiratory effort during mechanical ventilation to estimate the degree of spontaneous effort and elastic work. We compared the direction and degree of change in airway pressure during inspiratory holds versus esophageal pressure through secondary analysis of physiologic data from children with PARDS who had evidence of spontaneous respiration while on pressure control or pressure support ventilation. Children were enrolled from the intensive care units at Children’s Hospital Los Angeles. From airway pressure, we defined “plateau - peak pressure” as PMI, which was divided into three categories for analysis (< −1 (“negative”), between −1 and 1 (“neutral”), and > 1 cmH2O (“positive”). 30 children (age 36.8 (16.1–70.3) months) from 65 study days, comprising 118 inspiratory holds were included. PMI was “negative” in 29 cases, was “neutral” in 17 cases, and was “positive” in 72 cases. As PMI went from negative to neutral to positive, there was larger negative deflection in esophageal pressure −5.0 (−8.2–1.9), −5.9 (−7.6–4.3), and −10.7 (−18.1–7.9) cmH2O (p < 0.0001), respectively. There was a correlation between max negative esophageal pressure and PMI (r = −0.52), and when PMI was ≥ 7 cmH2O, the max negative esophageal pressure was >10 cmH2O. There was a stronger correlation between PMI and markers of elastic work from esophageal pressure (r = 0.84). The magnitude of plateau minus peak pressure during an inspiratory hold is correlated with the degree of inspiratory effort, particularly for those with high elastic work. It may be useful to identify patients with excessively high effort or high driving pressure.