Normalization to Predicted Body Weight May Underestimate Mechanical Energy in Pediatric Acute Respiratory Distress Syndrome.
Normalization to Predicted Body Weight May Underestimate Mechanical Energy in Pediatric Acute Respiratory Distress Syndrome.
复制标题
预测体重标准化可能会低估小儿急性呼吸窘迫综合征的机械能。
DOI：
10.1164/rccm.202111-2641le
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Khemani RG.
中科院分区：
文献类型：
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作者：
Ito Y;Takeuchi M;Inata Y;Kyogoku M;Hotz JC;Bhalla AK;Newth CJL;Khemani RG.
机械功率（MP）和机械能（ME）被认为是呼吸机诱导肺损伤（VILI）的统一决定因素。理论上，可以选择一种通气策略来最小化MP或ME，从而降低VILI的风险，尽管这一原则仍需要在临床试验中进行测试。然而，MP和ME都需要标准化以解释肺大小的差异，因为单位体积的能量是VILI的关键决定因素（1-3）。最典型的是，在成人和儿童中，肺体积测量归一化到预测体重（PBW）。然而，当考虑急性呼吸窘迫综合征（ARDS）患者时，“婴儿肺”的概念强化了肺容量，特别是FRC，比PBW预期的肺容量进一步减少。因此，有人建议将MP和ME与FRC归一化，在成年ARDS患者中，FRC归一化的MP与预后的关系比MP与其他参数归一化的关系更大(4)。然而，FRC通常不能用于临床。呼吸系统静态顺应性（Crs）可能是成年ARDS患者FRC的一个容易获得的替代指标，尽管肺顺应性（CL）更精确，并且似乎与成人FRC最成正比(5)。不幸的是，CL需要测量食管压（Pes）。
Mechanical power (MP) and mechanical energy (ME) have been proposed as unifying determinants of ventilator-induced lung injury (VILI). Theoretically, a ventilation strategy can be selected to minimize MP or ME, which should lower the risk for VILI, although this principle still needs to be tested in clinical trials. However, both MP and ME need to be normalized to account for differences in lung size because the energy per unit volume is a key determinant of VILI (1–3). Most typically, lung volume measurements are normalized to predicted body weight (PBW), in both adults and children. However, when considering patients with acute respiratory distress syndrome (ARDS), the “baby lung” concept reinforces that lung volumes, particularly FRC, are further reduced beyond what would be expected from PBW. As such, some suggest normalization of MP and ME to FRC, and in adult patients with ARDS, FRC-normalized MP is more associated with outcome than MP normalized to other parameters (4). However, FRC is often not available for clinical use. Respiratory system static compliance (Crs) may be a readily available surrogate for FRC in adult patients with ARDS, although lung compliance (CL) is more precise and appears to be most proportional to FRC in adults (5). Unfortunately, CL requires esophageal pressure (Pes) measurement.