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4DPRR- Index for predicting mortality in COVID-19 ARDS 4DPRR-预测COVID-19 ARDS死亡率的指标
Pub Date : 2022-06-15 DOI: 10.53097/jmv.10048
G. Paul, M. R. Krishna, Pl Gautam
Abstract Background Mortality in ARDS was reduced significantly after the introduction of the low tidal volume ventilation strategy. It has been recently shown that lung-protective ventilation strategies should primarily target driving pressure rather than Vt and that ventilator induced lung injury is not just dependent on tidal volume but also other factors like respiratory rate and driving pressure. Ventilator induced lung injury is also thought to be dependent on the amount of energy transferred by the ventilator to the patient which in turn is dependent on tidal volume size (VT), plateau pressure (Pplat), respiratory rate (RR). Mechanical power can be calculated accurately through power equations which can increase their applicability in clinical practice. One simple composite equation (driving pressure multiplied by four plus respiratory rate [4DPRR]) has been recently suggested as a simple surrogate for the power equation. This equation also doesn’t include PEEP as it has been theorized that it is the only elastic dynamic component of driving energy which affects the outcome and not the elastic static component (i.e., PEEP) and the resistive power (related to flow and airway resistance). Objectives To assess the mechanical power as measured by 4DPRR in mechanically ventilated patients who have moderate to severe COVID-19 ARDS. Methods: We obtained data on ventilatory variables and mechanical power from the patients who were admitted with moderate to severe COVID ARDS in our hospital from March 2021 to June 2021. Results We included 34 patients (28% women; mean age, 57 ± 17 yrs.). The average ΔP was 21.44 ± 3.98 cmH2O, the RR was 23.8 ± 3.84 breaths/min, and the mean driving pressure was 21.4 cmH2O. 28% (n = 10) of patients expired. There was no significant association of 4DPRR (P 0.72), Pplat (P 0.79).and RR (P 0.21) with mortality as predicted by area under ROC curves. Conclusions Driving power and plateau pressure were associated with mortality during controlled mechanical ventilation in COVID ARDS, but a simpler model of mechanical power using only the driving pressure and respiratory rate was found to be a poor predictor of mortality. Keywords: COVID-19, ARDS, Mechanical power, Driving pressure, Plateau pressure
背景:引入低潮气量通气策略后,ARDS的死亡率显著降低。最近的研究表明,肺保护性通气策略应主要针对驱动压而不是Vt,并且呼吸机引起的肺损伤不仅取决于潮气量,还取决于呼吸速率和驱动压等其他因素。呼吸机引起的肺损伤也被认为取决于呼吸机传递给患者的能量量,而能量量又取决于潮气量大小(VT)、平台压(Pplat)和呼吸速率(RR)。通过功率方程可以准确地计算出机械功率,增加了其在临床中的适用性。一个简单的复合方程(驾驶压力乘以4加上呼吸速率[4DPRR])最近被建议作为功率方程的简单替代。该方程也不包括PEEP,因为理论上认为它是驱动能量中唯一影响结果的弹性动态分量,而不是弹性静态分量(即PEEP)和阻力(与流动和气道阻力有关)。目的评价中~重度COVID-19 ARDS机械通气患者的4DPRR机械功率指标。方法:获取我院2021年3月至2021年6月收治的中重度COVID - ARDS患者的通气变量和机械功率数据。结果纳入34例患者(女性28%;平均年龄(57±17岁)。平均ΔP为21.44±3.98 cmH2O, RR为23.8±3.84次/min,平均驾驶压力为21.4 cmH2O。28% (n = 10)患者死亡。4DPRR (P 0.72)、Pplat (P 0.79)无显著相关性。ROC曲线下面积预测死亡率的RR (P 0.21)。结论驱动功率和平台压力与控制机械通气期间的死亡率相关,但仅使用驱动压力和呼吸速率的简单机械功率模型不能很好地预测死亡率。关键词:COVID-19, ARDS,机械动力,驱动压力,平台压力
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引用次数: 1
Mechanical power in AVM-2 versus conventional ventilation modes in a normal lung model: A bench study 正常肺模型中AVM-2与传统通气模式的机械通气能力:一项台架研究
Pub Date : 2022-06-15 DOI: 10.53097/jmv.10047
Parthav Shah, J. Yeo, W. Techasatian, Franck Claudio, Ehab Daoud
Introduction Recent studies suggested that the energy delivered by the mechanical ventilator to the lungs termed the mechanical power can induce and increase the risks of ventilator induced lung injury. The components of the mechanical power include the variables delivered by the ventilator: tidal volume, respiratory rate, inspiratory flow, airway pressure. Adaptive Ventilator Mode-2 (AVM-2) is a pressure-controlled mode with an optimal targeting scheme based on the inspiratory power equation that adjusts the respiratory rate and tidal volume to achieve a target minute ventilation. This mode conceptually should reduce the mechanical power delivered to the patients and thus reduce the incidence of ventilator induced lung injury. Methodology A bench study using a lung simulator (TTL, Michigan Instruments, Michigan, USA) was conducted. We constructed a passive single compartment normal respiratory mechanics model with compliance of 50 ml/cmH2O, and resistance of 10 cmH2O/L/s, with IBW 70 kg. We compared three different ventilator modes: Adaptive Ventilation Mode-2 (AVM-2), Pressure Regulated Volume Control (PRVC), and Volume Controlled Ventilation (VCV) in four different scenarios: 2 levels of minute ventilation 7 and 10.5 Lit/min (Experiment 1 and 2 respectively), each with 2 different PEEP levels 5 and 10 cmH2O (Experiment A and B respectively) termed Experiments 1A, 1B, 2A, and 2B respectively. The AVM-2 mode automatically selects the optimal tidal volume, and respiratory rate per the dialed percent minute ventilation with an I:E ratio of 1:1. In the PRVC, VCV we selected target tidal volume 6ml/kg/IBW (420 ml), and respiratory rate adjusted to match the minute ventilation for the AVM-2 mode. I:E ratio was kept 1:2 to avoid intrinsic PEEP. The study was conducted using a bellavista™ 1000 e Ventilator (Vyaire Medical, Illinois, USA). The mechanical power delivered by the ventilator for each mode was computed and compared between the three modes in each experiment. Statistical analysis was done using Kruskal-Wallis test to analyze the difference between the three modes, post HOC Tukey test was used to analyze the difference between each mode with the confidence intervals, P < 0.05 was considered statistically significant. Results There were statistically significant differences between all the three modes regarding the ventilator delivered mechanical power. The AVM-2 mode delivered significantly less mechanical power than VCV which in turn was less than PRVC. Experiment 1A: AVM-2 8.76 土 0.05, VCV 9.78 土 0.04, PRVC 10.82 土 0.08, P < 0.001 Experiment 1B: AVM-2 11.27 ± 0.09 VCV 12.81 ± 0.05, PRVC 13.88 ± 0.06, P < 0.001. Experiment 2A: AVM-2 14.76 ± 0.05, VCV 15.79 ± 0.05, PRVC 18.29 ± 0.07, P < 0.001, Experiment 2B: AVM-2 18.76 ± 0.04, VCV 20.56 ± 0.04, PRVC 21.17 土 0.03, P < 0.001. Discussion AVM2 mode delivered less mechanical power compared to two conventional modes using low tidal volume in a normal lung model. This might reduce the incidence of
近年来的研究表明,机械呼吸机向肺输送的能量称为机械功率,可诱发并增加呼吸机所致肺损伤的风险。机械动力的组成包括呼吸机输送的变量:潮气量、呼吸频率、吸气流量、气道压力。自适应呼吸机模式-2 (Adaptive Ventilator mode -2, AVM-2)是一种压力控制模式,基于吸气功率方程,通过调节呼吸频率和潮气量来实现目标分钟通气。这种模式在概念上应该减少传递给患者的机械功率,从而减少呼吸机所致肺损伤的发生率。方法采用肺模拟器(TTL, Michigan Instruments, Michigan, USA)进行台架研究。建立被动单室正常呼吸力学模型,顺应性为50 ml/cmH2O,阻力为10 cmH2O/L/s,体重70 kg。我们比较了三种不同的呼吸机模式:自适应通风模式-2 (AVM-2)、压力调节体积控制(PRVC)和体积控制通风(VCV)在四种不同的情况下:2个水平的分钟通风7和10.5 Lit/min(实验1和2),每一个都有2个不同的PEEP水平5和10 cmH2O(实验A和B),分别称为实验1A、1B、2A和2B。AVM-2模式自动选择最佳潮气量,呼吸率每拨号百分比分钟通风与1:1的I:E比。在PRVC和VCV中,我们选择目标潮气量6ml/kg/IBW (420 ml),并调整呼吸速率以匹配AVM-2模式的分钟通气。I:E比值保持1:2,避免内源性PEEP。本研究使用bellavista™1000e呼吸机(Vyaire Medical, Illinois, USA)进行。计算了每种模式下呼吸机的机械输出功率,并在每次实验中对三种模式进行了比较。采用Kruskal-Wallis检验分析三种模式之间的差异,采用post HOC Tukey检验分析各模式之间的差异,采用置信区间,P < 0.05为有统计学意义。结果三种模式呼吸机输出机械功率差异有统计学意义。AVM-2模式提供的机械功率明显低于VCV,而VCV又低于PRVC。实验1A: AVM-2 8.76±0.05,VCV 9.78±0.04,PRVC 10.82±0.08,P < 0.001实验1B: AVM-2 11.27±0.09 VCV 12.81±0.05,PRVC 13.88±0.06,P < 0.001。实验2A: AVM-2 14.76±0.05,VCV 15.79±0.05,PRVC 18.29±0.07,P < 0.001,实验2B: AVM-2 18.76±0.04,VCV 20.56±0.04,PRVC 21.17±0.03,P < 0.001。在正常肺模型中,与使用低潮气量的两种传统模式相比,AVM2模式提供的机械功率更小。这可能会减少呼吸机所致肺损伤的发生率。结果需要在更多的临床研究中得到验证。
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引用次数: 1
Pioneers in Mechanical Ventilation: Björn Jonson 机械通风的先驱:Björn Jonson
Pub Date : 2022-06-15 DOI: 10.53097/jmv.10050
Ehab Daoud
In this article, we highlight one of the pioneers of mechanical ventilation. Dr Björn Jonson is a physiologist, physician and currently a Professor Emeritus at Lund University in Sweden. He has spent the last sixty years of his life dedicated to research and inventions in the fields of respiratory failure and mechanical ventilation. With several devices invented, more than fifteen patents, more than 200 published articles and concepts, Dr. Jonson’s work has changed and revolutionized the way we understand the science of respiratory failure, and the way we practice and monitor mechanical ventilation today. More importantly, are the countless lives of patients saved all over the world because of his contribution. Keywords: Flow regulators, Servo Ventilator, Capnography
在本文中,我们将重点介绍机械通气的先驱之一。Björn Jonson博士是一位生理学家、内科医生,目前是瑞典隆德大学的名誉教授。他在生命的最后60年里致力于呼吸衰竭和机械通气领域的研究和发明。约翰逊博士发明了几种设备,拥有超过15项专利,发表了200多篇文章和概念,他的工作改变并彻底改变了我们理解呼吸衰竭科学的方式,以及我们今天实践和监测机械通气的方式。更重要的是,由于他的贡献,全世界无数病人的生命得以挽救。关键词:流量调节器,伺服通风机,毛细管造影
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引用次数: 0
Diaphragmatic Pacing in Spinal Cord Injury 膈肌起搏在脊髓损伤中的应用
Pub Date : 2022-06-15 DOI: 10.53097/jmv.10049
Parthav Shah, K. Benavente, T. Czech, W. Techasatian
Spinal Cord injury is a disabling condition which affects the respiratory system. The most affected neurological level is the cervical spine. Many patients with cervical spinal cord injury are unable to sustain independent ventilation and require mechanical ventilation. Long term use of mechanical ventilation is associated with poor quality of life, increased morbidity, and mortality. In patients with intact phrenic nerve, diaphragmatic pacing can be used to help wean the patients off mechanical ventilation. In this review, we summarize the indications, contraindications, benefits, safety, and effectiveness of diaphragmatic pacing. We also report a brief case of a 62-year-old male with quadriplegia secondary to C2-C3 fracture who was intubated after drowning but was extubated with the help of diaphragmatic pacing. Keywords: Cervical spinal injury, Diaphragmatic pacemaker, Mechanical Ventilation
脊髓损伤是一种影响呼吸系统的致残性疾病。受影响最大的神经系统是颈椎。许多颈脊髓损伤患者无法维持独立通气,需要机械通气。长期使用机械通气与生活质量差、发病率和死亡率增加有关。对于膈神经完整的患者,可以使用膈起搏来帮助患者脱离机械通气。在这篇综述中,我们总结了膈肌起搏的适应症、禁忌症、益处、安全性和有效性。我们还报告了一个简短的病例,一名62岁的男性,因C2-C3骨折继发四肢瘫痪,溺水后插管,但在膈肌起搏的帮助下拔管。关键词:颈椎损伤;膈肌起搏器;机械通气
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引用次数: 0
Airway obstruction by a folding metal rod within a Reinforced Oral tracheal Tube: Case Report 强化口气管管内折叠金属棒致气道阻塞1例报告
Pub Date : 2022-06-15 DOI: 10.53097/jmv.10051
C. Franck, Samuel da Rossa Sousa, Guilherme Voltolini, R. Melo, I. Moraes
The Reinforced Orotracheal Tube (ROT) is an airway device for intubation that allows invasive ventilation during general anesthesia. The ROT differs from a Conventional Endotracheal Tube (CET) by the presence of a stainless-steel spiral, which strengthens the wall and hinders collapse. The ROT can be used when there is a risk of obstructing the flow of gases through compression or elbowing of the endotracheal tube, during orofacial surgical procedures, neurosurgery or in non-supine surgical positions under deep general anesthesia. The metallic spiral, which reinforces the lumen of this endotracheal tube, is subject to damage and deformities that can compromise the permeability of its lumen. The ROT should be used only during the surgical procedure under deep general anesthesia. If there is a need for the permanence of orotracheal intubation in the postoperative period of patients referred to the intensive care unit, the ROT should be replaced by the polyvinyl chloride CET, given the risk of damage to the ROT due to bites with fracture of the metal rod and obstruction by folding, as in this case, which will be reported below. The rarity of similar reports in the literature and the severity of obstruction of an endotracheal tube causing severe hypoxemic disorders, guided the objective of this case report, which aims to guide preventive and resolving measures, in addition to including to the list of diagnoses of causes of acute obstructions of an endotracheal tube. Keywords: Airway obstruction; Armoured tube; intubation: mechanical ventilation.
强化口气管管(ROT)是一种用于插管的气道设备,在全身麻醉期间允许有创通气。ROT与传统气管内管(CET)的不同之处在于,它有一个不锈钢螺旋,可以加强管壁,防止塌陷。当压缩或肘压气管内管有阻碍气体流动的危险时,在口面部外科手术过程中,神经外科手术或在深度全身麻醉下的非仰卧手术姿势时,可以使用ROT。金属螺旋加强了气管内管的管腔,它容易受到损伤和变形,从而影响管腔的渗透性。ROT只能在深度全身麻醉下的手术过程中使用。如果在转到重症监护病房的患者术后需要永久性的口气管插管,考虑到金属棒断裂咬伤和折叠阻塞可能导致ROT受损的风险,应使用聚氯乙烯CET代替ROT,就像本病例一样,这将在下面报道。文献中类似报道的罕见性和气管内管阻塞引起严重低氧血症的严重性,指导了本病例报告的目的,旨在指导预防和解决措施,并将急性气管内管阻塞的原因列入诊断清单。关键词:气道阻塞;铠装管;插管:机械通气。
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引用次数: 0
Influence of age, mechanical power, its fragments and components on the mortality rate in SARS-CoV-2 patients undergoing mechanical ventilation 年龄、机械动力及其碎片和部件对机械通气SARS-CoV-2患者死亡率的影响
Pub Date : 2022-03-15 DOI: 10.53097/jmv.10041
C. Franck, Gustavo Maysonnave Franck, Raquel Galvão Feronato
Introduction The Acute Respiratory Distress Syndrome caused by the Coronavirus 2019 (SARS-CoV-2) may be associated with the Acute Respiratory Distress Syndrome (ARDS) and Ventilation Induced Lung Injury (VILI). However, there are still doubts about the potential damage generators and their influences on patient outcome. Objective To analyze the mechanical ventilation factors that influence the mortality in SARS-CoV-2. Assess the outcomes based on age, on parameters of the mechanical ventilator, on Mechanical Power and on its fragments through univariate and multivariate analysis of age, PEEP, Driving Pressure, elastance. Method Observational, longitudinal, prospective, analytical, and quantitative study of age and of the parameters of the mechanical ventilator, alongside the calculous of the Mechanical Power and its components of patients with SARS-CoV-2. Results We identified significant impact on the outcome in the univariate analysis of age (p<0.001), respiratory rate (p=0.047), elastance (p<0.001), compliance (p<0.001), driving pressure (p<0.001), inspiratory pressure variation (p<0.001), peak airway pressure (p=0.009), plateau pressure (p<0.013), PEEP (p<0.001), dynamic elastic power (p<0.001) and static elastic power (p=0.005). In the multivariate analysis the increase in age (p<0.001), in elastance (p=0.0029) and in Mechanical Power (p=0.023), and the reduction in PEEP (p=0.044) showed significant impact on the death risk. Conclusion The increase in age and in mechanical power with increased dynamic elastic power and decreased static elastic power influenced the mortality rate of patients with SARS-CoV-2 undergoing mechanical ventilation, i.e. it is related to the increase in driving pressure to overcome a high elastance and low capacity to recruit for PEEP.
2019冠状病毒引起的急性呼吸窘迫综合征(SARS-CoV-2)可能与急性呼吸窘迫综合征(ARDS)和通气性肺损伤(VILI)相关。然而,对于潜在的损伤产生者及其对患者预后的影响仍存在疑问。目的分析影响SARS-CoV-2致死率的机械通气因素。通过年龄、PEEP、驱动压力、弹性的单因素和多因素分析,评估基于年龄、机械呼吸机参数、机械功率及其碎片的结果。方法对SARS-CoV-2患者的年龄和机械呼吸机参数进行观察性、纵向、前瞻性、分析性和定量研究,并计算机械功率及其组成。结果年龄(p<0.001)、呼吸频率(p=0.047)、弹性(p<0.001)、依从性(p<0.001)、驱动压力(p<0.001)、吸气压力变化(p<0.001)、气道峰值压力(p=0.009)、平台压力(p<0.013)、PEEP (p<0.001)、动态弹性功率(p<0.001)和静态弹性功率(p=0.005)对结果有显著影响。在多因素分析中,年龄(p<0.001)、弹性(p=0.0029)和机械动力(p=0.023)的增加以及PEEP (p=0.044)的降低对死亡风险有显著影响。结论年龄和机械功率的增加(动态弹性功率增加,静态弹性功率降低)影响机械通气患者的死亡率,即与克服高弹性和低PEEP招募能力的驱动压力增加有关。
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引用次数: 0
History of Intermittent Mandatory Ventilation 1971 to present. Part two 间歇性强制通气史1971年至今。第二部分
Pub Date : 2022-03-15 DOI: 10.53097/jmv.10043
Ronald Sanderson, C. Rogers
Medical history is often overlooked as advances keep moving forward. Seldom is it that advances in medicine are truly new, unique ideas, but rather built on ideas that have been considered before. Even our latest developments will become history or forgotten as science and medicine advance. This history of intermittent mandatory ventilation (IMV) is a two-part article in which the first part attempts to show that the concepts and apparatus that involve the now common mode of ventilation have been considered and described for nearly 200 years, if not earlier. This older history is not brought forward to diminish what has been done in the last 50 years, but to enhance awareness of how ideas and even mechanical ventilators change over time. This second part will describe how those ideas and mechanics changed into what we now call IMV in its many forms.
随着进步的不断推进,医学史经常被忽视。医学的进步很少是真正新的、独特的想法,而是建立在以前考虑过的想法之上。随着科学和医学的发展,即使是我们的最新进展也将成为历史或被遗忘。间歇性强制通风(IMV)的历史是一篇由两部分组成的文章,其中第一部分试图表明,涉及现在常见的通风模式的概念和设备已经被考虑和描述了近200年,如果不是更早的话。这段古老的历史并不是为了减少过去50年所做的事情,而是为了提高人们对思想甚至机械呼吸机如何随着时间的推移而变化的认识。第二部分将描述这些想法和机制是如何以多种形式转变为我们现在所说的IMV的。
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引用次数: 0
Identifying asynchronies: Delayed cycling 识别异步:延迟循环
Pub Date : 2022-03-15 DOI: 10.53097/jmv.10045
Victor Perez, Jamille Pasco
Patient-ventilator asynchrony/dysynchrony is a mismatch between the patient and the ventilator's delivered breaths and the ability of the ventilator to meet the patient demands. Any factor that alters the harmony between these two components produces asynchrony, which can cause discomfort and an increase in the patient's work of breathing. Delayed cycling occurs when the neural time is less than the mechanical time of the ventilator. Keywords: asynchrony, ventilator, delayed cycling, work of breathing, neural time, mechanical time.
患者与呼吸机的不同步/不同步是患者与呼吸机输送的呼吸以及呼吸机满足患者需求的能力之间的不匹配。任何改变这两个组成部分之间的和谐的因素都会产生不同步,这可能导致不适并增加患者的呼吸工作。当神经时间小于呼吸机的机械时间时,出现延迟循环。关键词:异步,呼吸机,延迟循环,呼吸功,神经时间,机械时间
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引用次数: 1
Application of the prone position during COVID-19 pandemic. (PROCOV). An international survey of clinicians COVID-19大流行期间俯卧位的应用(PROCOV)。一项国际临床医生调查
Pub Date : 2022-03-15 DOI: 10.53097/jmv.10042
K. Benavente, S. Yoshimura, James Davis, A. Dhupa, Ehab Daoud
Background Benefits of the prone position in ARDS are well established, and the evidence of its benefits for the COVID-19 patients are growing. However, the clinical utilization of such a maneuver is less established. We attempted to analyze the clinician’s utilization and attitude of the prone position and what is the main drive for its usage. Methods An international survey of eight questions. The questionnaire was anonymous and included the country of practice, percentage of patients with COVID-19 they have placed in the prone position while undergoing mechanical ventilation, most important factor that determined the need for the prone position (SpO2, PaO2:FiO2, FIO2, PEEP), duration of prone position in hours/day, use of neuro-muscular blocking agents, body position (flat, trendelenburg, reverse trendelenburg), the use of a specific protocol for the prone position, if they believe that prone position is beneficial, and if their practice will change or not. The survey was active for five months. Statistical analysis included frequencies of each response, as well as subgroup analyses designed to identify potential correlates of longer or shorter proning durations. The questionnaire assessed clinicians optimism regarding the continuing use of proning in the future, and how different cutoffs for proning initiation may be associated with attitudes towards proning. Associations between categorical variables were analyzed using Fisher’s exact test. A P-value of < 0.05 was considered statistically significant. Results are expressed in Means ± Standard Deviation (SD) Results 294 questionnaires were collected from 35 countries with 78% of responders from the USA. Median duration of proning was 14.8 ± 2.8 hours per day. 74% of clinicians utilized an established protocol for proning their patients. The decision to initiate proning was non-significant and split between the use of oxygen saturation SpO2 (30%) mean 92.44 ± 5.61, PaO2:FiO2 ratio (28%) mean 188.44 ± 57.36, FiO2 mean 78.6 ± 15.65, PEEP mean 12.96 ± 4.66, or immediate prone positioning following intubation (22%). 41.2% of surveyed utilize the prone position in 25-50%, average percent patients proned calculated at 7.1%. Estimated 77% of respondents reported prone positioning to be helpful in 50% or less of cases. 91% of responders used NMB either always or frequently, and there was statistical significance between the use of NMB and perceived benefits of proning (P < 0.001). 74% of those surveyed use a protocol for proning, the use of protocol and the perceived benefits of proning was statistically significant (P <0.001). Conclusion There are few agreements between clinicians on the duration of the proning sessions and use of NMB and using a protocol for proning. There was no agreement on the trigger of the prone position or the belief of its usefulness. This ambiguity should trigger an evidence-based ARDS management using the prone position in COVID-19 patients.
背景俯卧位对ARDS的益处已得到充分证实,其对新冠肺炎患者益处的证据正在增加。然而,这种手法的临床应用尚不成熟。我们试图分析临床医生对俯卧姿势的使用和态度,以及俯卧姿势使用的主要驱动力是什么。方法对8个问题进行国际调查。该问卷是匿名的,包括实践国家、新冠肺炎患者在接受机械通气时采用俯卧位的百分比、决定俯卧位需求的最重要因素(SpO2、PaO2:FiO2、FiO2、PEEP)、俯卧位持续时间(小时/天)、神经肌肉阻滞剂的使用、,体位(平躺、俯卧、反俯卧),俯卧姿势的特定方案的使用,如果他们认为俯卧姿势是有益的,以及他们的练习是否会改变。这项调查持续了五个月。统计分析包括每种反应的频率,以及旨在确定更长或更短内旋持续时间的潜在相关性的亚组分析。该问卷评估了临床医生对未来继续使用内旋的乐观态度,以及内旋起始的不同切入点如何与对内旋的态度相关。使用Fisher精确检验分析分类变量之间的相关性。P值<0.05被认为具有统计学意义。结果以平均值±标准差(SD)表示。结果从35个国家收集了294份问卷,78%的应答者来自美国。内旋的中位持续时间为每天14.8±2.8小时。74%的临床医生使用既定的方案对患者进行俯卧撑。开始俯卧的决定并不显著,分为血氧饱和度SpO2(30%)平均值92.44±5.61,PaO2:FiO2比率(28%)平均值188.44±57.36,FiO2平均值78.6±15.65,PEEP平均值12.96±4.66,或插管后立即俯卧位(22%)。41.2%的受访者采用俯卧姿势的比例为25-50%,平均百分比为7.1%。据估计,77%的受访者表示,俯卧姿势在50%或更少的情况下有帮助。91%的应答者总是或频繁地使用NMB,NMB的使用与内旋的感知益处之间存在统计学意义(P<0.001)。74%的受访者使用内旋方案,方案的使用和内旋的感知益处具有统计学意义(P<0.001)。结论临床医生之间对内旋疗程的持续时间、NMB的使用和使用内旋方案几乎没有达成一致。对于俯卧姿势的触发因素或对其有用性的信念没有达成一致。这种模糊性应该触发新冠肺炎患者使用俯卧位进行循证ARDS管理。
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引用次数: 0
Flexible bronchoscopy during mechanical ventilation. Why and why not 机械通气期间的柔性支气管镜检查。为什么和为什么不
Pub Date : 2022-03-15 DOI: 10.53097/jmv.10044
K. Benavente, Kimiyo H. Yamasaki, Ehab Daoud
Flexible bronchoscopy has been utilized in the intensive care units and in mechanically ventilated patients for many decades. The procedure is reasonably safe and has wide range of diagnostic and therapeutic benefits in patients undergoing mechanical ventilation. Though guidelines exist for bronchoscopy in adults in general and for those in the intensive care units (ICU), there are no guidelines specifically established for bronchoscopy during mechanical ventilation. In this review, we try to summarize the indications (Why), physiologic effects of bronchoscopy, complications, and the contraindications (Why not) to the use of this procedure and the evidence behind it. Special section on the single use disposable bronchoscopes and the use of bronchoscopy during the COVID-19 era are discussed.
几十年来,柔性支气管镜一直被用于重症监护室和机械通气患者。该手术相当安全,对接受机械通气的患者具有广泛的诊断和治疗益处。尽管有针对成人和重症监护室(ICU)患者的支气管镜检查指南,但没有专门针对机械通气期间的支气管镜检测制定的指南。在这篇综述中,我们试图总结支气管镜检查的适应症(为什么)、生理效果、并发症、使用该方法的禁忌症(为什么不)及其背后的证据。讨论了新冠肺炎时代一次性使用支气管镜和支气管镜检查使用的特别章节。
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Journal of mechanical ventilation
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