End-inspiratory airway occlusion - A method to assess the pressure developed by inspiratory muscles in patients with acute lung injury undergoing pressure support
End-inspiratory airway occlusion - A method to assess the pressure developed by inspiratory muscles in patients with acute lung injury undergoing pressure support
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DOI：
10.1164/ajrccm.156.4.96-02031
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发表时间：
1997-10-01
影响因子：
24.7
通讯作者：
Pesenti, A
中科院分区：
文献类型：
--
作者：
Foti, G;Cereda, M;Pesenti, A
我们评估了吸气末闭塞操作作为估计压力支持通气 (PS) 期间吸气努力的一种方法。在 9 名非阻塞性急性肺损伤 (ALI) 患者中，我们应用了四种水平的 PS（0、5、10、15 cm H2O）来调整吸气力度。在每个实验期结束时按下呼吸机（Servo 900 C；西门子，柏林，德国）的吸气保持按钮进行吸气末闭塞（2 至 3 秒）。我们将吸气末闭塞平台压与闭塞前气道压力（PEEP + PS）之间的差值作为吸气努力的估计值，并将其称为 PMI（Pmusc，指数）。从食管压力追踪中，我们获得了参考测量值：吸气末吸气肌产生的压力 (Pmusc,ei) 以及每次呼吸 (PTP/b) 和每分钟 (PTP/min) 的压力-时间乘积。在每位患者中，PMI 与 Pmusc,ei (p < 0.01) 和 PTP/b (p < 0.01) 相关，6 cm H2O 的 PMI 阈值检测到 PTP/min < 125 cm H2O s/min，灵敏度为 0.89，特异性为 0.89。我们得出结论，PMI 是对 ALI 患者吸气肌产生的压力的良好估计，可用于滴定 PS 水平。 PMI 的主要优点是： 无需任何额外设备即可从呼吸机显示屏获取。
We evaluated the end-inspiratory occlusion maneuver as a means to estimate the inspiratory effort during pressure support ventilation (PS). In nine nonobstructed acute lung injury (ALI) patients, we applied four levels of PS (0, 5, 10, 15 cm H2O) to modify the inspiratory effort. End inspiratory occlusions (2 to 3 s) were performed at the end of each experimental period by pushing the inspiratory hold button of the ventilator (Servo 900 C; Siemens, Berlin, Germany). We took the difference between the end-inspiratory occlusion plateau pressure and the airway pressure before the occlusion (PEEP + PS) as an estimate of the inspiratory effort and called it PMI (Pmusc,index). From the esophageal pressure tracing we obtained a reference measurement: of the pressure developed by the inspiratory muscles at end inspiration (Pmusc,ei) and of the pressure-time product per breath (PTP/b) and per minute (PTP/min). In each patient, PMI was correlated with Pmusc,ei (p < 0.01) and PTP/b (p < 0.01), A PMI threshold of 6 cm H2O detected PTP/min < 125 cm H2O s/min with a sensitivity of 0.89 and a specificity of 0.89. We conclude that PMI is a good estimate of the pressure developed by the inspiratory muscles in ALI patients and may be used to titrate PS level. The major advantage of PMI is that it: can be obtained from the ventilator display without any additional equipment.