Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome
Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome
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DOI：
10.1164/rccm.200607-915oc
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发表时间：
2007-01-15
影响因子：
24.7
通讯作者：
Ranieri, V. Marco
中科院分区：
文献类型：
--
作者：
Terragni, Pier Paolo;Rosboch, Giulio;Ranieri, V. Marco
原理：潮气量和平台压限制可降低急性呼吸窘迫综合征的死亡率。计算机断层扫描显示，一个小的，正常充气室的顶部充气不足和nonaerated隔间，可能是过度膨胀的潮汐inflation.Objectives：我们假设，尽管潮气量和平台压力的限制，患者与一个较大的nonaerated隔间暴露于潮汐过度膨胀的正常充气室。测量和主要结果：对30例采用低潮气量（6 ml/kg预测体重）通气的患者进行呼气末和吸气末肺计算机断层扫描。聚类分析确定了20例患者的潮气膨胀主要发生在正常充气的隔室中（69.9 +/- 6.9%;“更多保护”），10例患者的潮气膨胀主要发生在过度充气的隔室中（63.0 +/- 12.7%;“更少保护”）。与保护程度较低的患者相比，保护程度较高的患者的非通气室较小，正常通气室较大（p = 0.01）。肺细胞因子在保护程度高的患者中低于保护程度低的患者（p < 0.05）。无呼吸机天数在保护程度较高和保护程度较低的患者中分别为7 +/- 8和1 +/- 2 d（p = 0.01）。平台压力范围在25和26厘米水柱之间的更多的保护患者和28和30厘米水柱之间的保护较少的患者（p = 0.006）。结论：限制潮气量为6毫升/公斤预测体重和平台压力为30厘米水柱可能是不够的，患者的特点是一个较大的非充气室。
Rationale: Tidal volume and plateau pressure limitation decreases mortality in acute respiratory distress syndrome. Computed tomography demonstrated a small, normally aerated compartment on the top of poorly aerated and nonaerated compartments that may be hyperinflated by tidal inflation.Objectives: We hypothesized that despite tidal volume and plateau pressure limitation, patients with a larger nonaerated compartment are exposed to tidal hyperinflation of the normally aerated compartment.Measurements and Main Results: Pulmonary computed tomography at end-expiration and end-inspiration was obtained in 30 patients ventilated with a low tidal volume (6 ml/kg predicted body weight). Cluster analysis identified 20 patients in whom tidal inflation occurred largely in the normally aerated compartment (69.9 +/- 6.9%; "more protected"), and 10 patients in whom tidal inflation occurred largely within the hyperinflated compartments (63.0 +/- 12.7%; "less protected"). The nonaerated compartment was smaller and the normally aerated compartment was larger in the more protected patients than in the less protected patients (p = 0.01). Pulmonary cytokines were lower in the more protected patients than in the less protected patients (p < 0.05). Ventilator-free days were 7 +/- 8 and 1 +/- 2 d in the more protected and less protected patients, respectively (p = 0.01). Plateau pressure ranged between 25 and 26 cm H2O in the more protected patients and between 28 and 30 cm H2O in the less protected patients (p = 0.006).Conclusions: Limiting tidal volume to 6 ml/kg predicted body weight and plateau pressure to 30 cm H2O may not be sufficient in patients characterized by a larger nonaerated compartment.