Interrupter mechanics of patients admitted to a chronic ventilator dependency unit.
Interrupter mechanics of patients admitted to a chronic ventilator dependency unit.
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入住慢性呼吸机依赖病房的患者的中断机械师。
DOI：
10.1164/ajrccm/148.1.127
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Hubmayr,RD
中科院分区：
文献类型：
--
作者：
Reinoso,MA;Gracey,DR;Hubmayr,RD
我们分析了73例连续入住慢性呼吸机依赖病房的患者的中断器力学测试结果。本研究的目的是（1）建立基于阻断器力学测量的气道阻塞严重程度分级指南;（2）估计该人群中气道阻塞的患病率;（3）将阻断器试验结果与气道功能的临床评估进行比较;（4）表征支气管扩张剂诱导的等反冲流变化的分布。73例患者中有65例（890/0）的测量结果被认为在技术上足够。在65例患者中，29例（45%）在被动呼气期间显示出血流受限的迹象。在临床稳定性期间通过肺量测定法记录的所有严重阻塞患者均为流量受限，并在10 cm H2O的反冲压力下实现最大流量~ 0.45 Us。与呼气动力学指标相比，呼吸系统吸气阻力是反映阻塞严重程度的不良指标。在12例患者中，7例中断试验未能证实严重梗阻的临床诊断，而在25例患者中，6例（24%）显示了意外梗阻。给予270 J. 1 g沙丁胺醇使41例患者中29%的患者在相当的反冲压力下的流量增加约0.1 Us。血流变化呈单峰分布，与梗阻严重程度无关。总之，在呼吸机依赖患者中常规使用中断器技术有助于确定气道阻塞的严重程度和患病率，有助于识别具有其他未被怀疑的呼气气流限制的患者或临床上怀疑但不能证实该诊断的患者，并有助于评估个体对支气管扩张剂的反应。和流量提供了量化插管、机械通气患者的呼吸系统力学的手段（1，2）。中断器技术使医生能够确定被动呼气期间放松的呼吸系统的弹性和流动阻力特性（2）。在以前的研究中，该技术已被用于检测呼气气流限制，量化动态过度充气的程度，并评估插管患者的支气管扩张剂反应性（2-5）。
We analyzed the results of interrupter mechanics tests of 73 consecutive patients who were admitted to a chronic ventilator dependency unit. The purposes of this study were (1) to establish guidelines for grading the severity of airway obstruction based on interrupter mechanics measurements;(2) to estimate the prevalence of airway obstruction in this population;(3) to compare interrupter test results with the clinical assessment of airway function; and (4) to characterize the distribution of bronchodilator-induced changes in isorecoil flow. Measurements from 65 of 73 patients (890/0) were considered technically adequate. Of 65 patients, 29 (45%) showed signs of flow limitation during passive expiration. All patients with severe obstruction documented with spirometry during clinical stability were flow-limited and achieved maximal flows~ 0.45 Us at recoil pressures of 10 cm H20. In contrast to measures of expiratory dynamics, the inspiratory resistance of the respiratory system was a poor index of severity of obstruction. In seven of 12 patients, interrupter testing failed to substantiate a clinical diagnosis of severe obstruction while revealing unsuspected obstruction in six of 25 (24%) patients. The administration of 270 J. 1g of albuterol increased flows at comparable recoil pressures by~ 0.1 Us in 29% of 41 patients. Changes in flow were unimodally distributed and were not correlated with severity of obstruction. In summary, the routine use of the interrupter technique in ventilatordependent patients is helpful in determining the severity and prevalence of airway obstruction, in identifying patients with otherwise unsuspected expiratory airflow limitation or those in whom this diagnosis is clinically suspected but cannot be substantiated, and in assessing the individual responses to bronchodilators.Measurements of airway pressure, volume, and flow offer means to quantify respiratory system mechanics in intubated, mechanically ventilated patients (1, 2). The interrupter technique allows the physician to determine the elastic and flow-resistive properties of the relaxed respiratory system during passive exhalation (2). In previous studies this technique has been used to detect expiratory airflow limitation, to quantify the degree of dynamic hyperinflation, and to evaluate the bronchodilator responsiveness of intubated patients (2-5).