Estimation of end-expiratory lung volume variations by optoelectronic plethysmography
Estimation of end-expiratory lung volume variations by optoelectronic plethysmography
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DOI：
10.1097/00003246-200109000-00026
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发表时间：
2001-09-01
影响因子：
8.8
通讯作者：
Gattinoni, L
中科院分区：
文献类型：
--
作者：
Dellacà, RL;Aliverti, A;Gattinoni, L
目的：测试光电体积描记术（OEP）监测机械通气瘫痪患者呼气末正压（PEEP）诱导的呼气末肺容积（EELV）变化的能力。设计：实验室和临床调查。设置：Ospedale Maggiore Policlinico di Milano的重症监护室。患者。共有8名患者出现不同程度的呼吸衰竭，镇静剂和瘫痪。干预。PEEP相对于基线PEEP 10 cm H2O的变化（+/-5 cm H2O）。测量和主要结果：在模型方案中，我们通过在21小时内每30分钟重复测量塑料躯干模型的体积来测试OEP的再现性。躯干模型的OEP测量值（9337 mL值）的变化范围为16 mL（SD = 4 mL）。在患者方案中，我们通过呼气末正压（OEP）在PEEP增加/减少之前、期间和之后逐次呼吸测量胸壁呼气末容积（EEVCW），并将其变化与氦稀释技术测量的EELV的相应变化进行比较。氦测得的EELV变化与OEP测得的EEVCW变化之间的回归线非常接近同一线（斜率1.06，截距-0.02L，r（2）= 0.89），两者的差异与绝对值无关。PEEP增加后，EEVCW在大约15次呼吸后达到新的稳定状态; PEEP减少后，在3-4次呼吸后达到新的稳定状态。结论：EEVCW的OEP测量能准确反映EELV的变化。此外，OEP允许连续的房室分析，即使在不稳定的条件下。
Objective: To test the capability of optoelectronic plethysmography (OEP) to monitor positive end-expiratory pressure (PEEP)induced changes of end-expiratory lung volume (EELV) changes in mechanically ventilated paralyzed patients.Design: Laboratory and clinical investigation.Setting: Intensive care unit of the Ospedale Maggiore Policlinico di Milano.Patients. A total of eight patients with respiratory failure of various degrees, sedated and paralyzed. Interventions. PEEP variations (+/-5 cm H2O) relative to the baseline PEEP of 10 cm H2O.Measurements and Main Results: In the model protocol, we tested the reproducibility of the OEP by repeating volume measurements of a plastic torso model over a 21-hr period, every 30 mins. The variations of OEP measurements of the torso model (9337 mL value) were encountered in a range of 16 mL (SD = 4 mL). In the patient protocol, we measured the end-expiratory volume of the chest wall (EEVCW) breath-by-breath by OEP before, during, and after the PEEP increase/decrease and we compared its variations with the corresponding variations of EELV measured by helium dilution technique. The regression line between EELV changes measured by helium and EEVCW changes measured by OEP resulted very close to the identity line (slope 1.06, intercept -0.02 L, r(2) = 0.89) and their difference was not related to their absolute magnitude. After PEEP increase, the new steady state of EEVCW was reached approximately in 15 breaths; and, after PEEP decrease, in 3-4 breaths. The slow increase in EEVCW was mainly because of the abdominal compartment.Conclusion: OEP measurements of EEVCW accurately reflect the changes of EELV. Furthermore, OEP allows a continuous compartmental analysis, even during unsteady conditions.