The influence of different spontaneous breathing trials on regional ventilation distribution in patients with prolonged mechanical ventilation

IF 1.9 4区医学 Q3 PHYSIOLOGY Respiratory Physiology & Neurobiology Pub Date : 2024-06-13 DOI:10.1016/j.resp.2024.104296

Pu Wang , Mei-Yun Chang , Hai-Yen Hsia , Meng Dai , Yifan Liu , Yeong-Long Hsu , Feng Fu , Zhanqi Zhao

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Abstract

Objective

This study aimed to explore the influence of different spontaneous breathing trials (SBTs) on regional ventilation distribution in patients with prolonged mechanical ventilation (PMV).

Methods

A total of 24 patients with PMV were analyzed retrospectively. They received three different SBT modes which are automatic tube compensation (ATC), continuous positive airway pressure (CPAP), and T-piece (TP), over three days, and every SBT lasted two hours. Electrical impedance tomography (EIT) was used to monitor the SBT process and five-minute EIT data from five periods (pre-SBT which is t0, at the beginning and the end of the first hour SBT are t1 and t2, at the beginning and the end of the second hour SBT are t3 and t4) were analyzed.

Results

In all PMV patients, the temporal skew of aeration (TSA) values at t3 were significantly different in three SBTs (ATC: 18.18±22.97; CPAP: 20.42±17.01; TP:11.26±11.79; p=0.05). In the weaning success group, TSA (t1) values were significantly different too (ATC: 11.11±13.88; CPAP: 19.09±15.77; TP: 9.09±12.74; p=0.04). In the weaning failure group, TSA (t4) values were significantly different in three SBTs (ATC: 36.67±18.46; CPAP: 15.38±11.69; TP: 17.65±17.93; p=0.04). The patient’s inspiratory effort (Global flow index at t1) in patients with weaning failure under CPAP (3.51±4.31) was significantly higher than that in the ATC (1.15±1.47) and TP (0.89±1.28). The SBT mode with the best ventilation uniformity may be the one that activates the respiratory muscles the most which may be the optimal SBT. The SBT mode of most uniform ventilation distribution settings varies from patient to patient.

Conclusion

The regional ventilation distribution was different for each individual, making the SBT with the best ventilation distribution of patients need to be personalized. EIT is a tool that can be considered for real-time assessment.

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不同的自主呼吸试验对长期机械通气患者区域通气分布的影响。

研究目的本研究旨在探讨不同的自主呼吸试验（SBT）对长期机械通气（PMV）患者区域通气分布的影响：回顾性分析了 24 名 PMV 患者。他们在三天内接受了三种不同的 SBT 模式，分别是自动管道补偿（ATC）、持续气道正压（CPAP）和 T 片（TP），每次 SBT 持续两小时。电阻抗断层扫描（EIT）用于监测 SBT 过程，并对五个时段（SBT 前为 t0，SBT 第一小时开始和结束时为 t1 和 t2，SBT 第二小时开始和结束时为 t3 和 t4）的五分钟 EIT 数据进行了分析：在所有 PMV 患者中，三个 SBT 在 t3 时的通气时间偏差（TSA）值有显著差异（ATC：18.18±22.97；CPAP：20.42±17.01；TP：11.26±11.79；P=0.05）。在断奶成功组，TSA（t1）值也有显著差异（ATC：11.11±13.88；CPAP：19.09±15.77；TP：9.09±12.74；P=0.04）。在断奶失败组中，三个 SBT 的 TSA（t4）值有显著差异（ATC：36.67±18.46；CPAP：15.38±11.69；TP：17.65±17.93；P=0.04）。CPAP 下断奶失败患者的吸气努力（t1 时的全流量指数）（3.51±4.31）明显高于 ATC（1.15±1.47）和 TP（0.89±1.28）。通气均匀性最好的 SBT 模式可能是最能激活呼吸肌的模式，也可能是最佳的 SBT 模式。结论：通气分布最均匀的 SBT 模式因人而异：结论：每个人的区域通气分布都不相同，因此需要为患者选择个性化的最佳通气分布 SBT。EIT 是一种可用于实时评估的工具。

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来源期刊

Respiratory Physiology & Neurobiology 医学-呼吸系统

CiteScore

4.80

自引率

8.70%

发文量

104

审稿时长

54 days

期刊介绍： Respiratory Physiology & Neurobiology (RESPNB) publishes original articles and invited reviews concerning physiology and pathophysiology of respiration in its broadest sense. Although a special focus is on topics in neurobiology, high quality papers in respiratory molecular and cellular biology are also welcome, as are high-quality papers in traditional areas, such as: -Mechanics of breathing- Gas exchange and acid-base balance- Respiration at rest and exercise- Respiration in unusual conditions, like high or low pressure or changes of temperature, low ambient oxygen- Embryonic and adult respiration- Comparative respiratory physiology. Papers on clinical aspects, original methods, as well as theoretical papers are also considered as long as they foster the understanding of respiratory physiology and pathophysiology.