Daniel Ben-Aderet , João HN. Soares , Melissa LC. Bueno
{"title":"增大阻力对容量控制通气过程中两种临床监护仪评估的动态顺应性的影响：一项试肺研究","authors":"Daniel Ben-Aderet , João HN. Soares , Melissa LC. Bueno","doi":"10.1016/j.vaa.2024.03.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the effect of increased respiratory system resistance (R<sub>RS</sub>) on dynamic compliance (C<sub>dyn</sub>) assessed by the NM3 monitor (C<sub>dyn(NM3)</sub>) and the E-CAiOV module (C<sub>dyn(ECAiOV)</sub>).</p></div><div><h3>Study design</h3><p>Prospective laboratory study.</p></div><div><h3>Methods</h3><p>A training test lung (TTL) simulated the mechanical ventilation of a mammal with 50 and 300 mL tidal volumes in three conditions of R<sub>RS</sub> [normal (R<sub>BL</sub>), moderately increased (R<sub>1</sub>) and severely increased (R<sub>2</sub>)] and a wide range of clinically relevant C<sub>dyn</sub>. Simulations at increased R<sub>RS</sub> were paired with simulations at R<sub>BL</sub> with the same static compliance for comparisons. Pearson’s correlation coefficient and concordance correlation coefficient between the measurements at R<sub>BL</sub> with the ones with increased R<sub>RS</sub> were calculated. Bland–Altman plots were also used to evaluate the agreement of C<sub>dyn(ECAiOV)</sub> and C<sub>dyn(NM3)</sub> at R<sub>BL</sub> (control values) with their paired values at R<sub>1</sub> and R<sub>2</sub>. Relative bias and limits of agreement (LOAs) were calculated and LOAs larger than 30% were considered unacceptable. Trending ability of C<sub>dyn(NM3)</sub> and C<sub>dyn(ECAiOV)</sub> were evaluated by polar plots. Values of <em>p</em> < 0.05 were considered significant.</p></div><div><h3>Results</h3><p>The effect of increased R<sub>RS</sub> was more pronounced for C<sub>dyn(ECAiOV)</sub> than for C<sub>dyn(NM3)</sub>. Unacceptable agreement was only observed in C<sub>dyn(NM3)</sub> at R<sub>2</sub> in the 300 mL simulation (bias = –18.3% and lower LOA = –45%). For C<sub>dyn(ECAiOV)</sub>, agreement was unacceptable for all tested R<sub>RS</sub> in both simulations, being the worst at R<sub>2</sub> in the 300 mL simulation (bias = –54.7% and lower LOA = –100.2%). Both levels of increased R<sub>RS</sub> caused poor trending ability for C<sub>dyn(ECAiOV)</sub>, whereas the same effect was only observed for C<sub>dyn(NM3)</sub> at R<sub>2</sub>.</p></div><div><h3>Conclusions and clinical relevance</h3><p>In the presence of increased R<sub>RS</sub>, C<sub>dyn</sub> estimated by the NM3 monitor presented better capability to distinguish between changes in R<sub>RS</sub> from changes in respiratory system compliance.</p></div>","PeriodicalId":23626,"journal":{"name":"Veterinary anaesthesia and analgesia","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1467298724000357/pdfft?md5=53c3ee0552a231fb055ff80e9f31d9cc&pid=1-s2.0-S1467298724000357-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Effect of increased resistance on dynamic compliance assessed by two clinical monitors during volume-controlled ventilation: A test-lung study\",\"authors\":\"Daniel Ben-Aderet , João HN. Soares , Melissa LC. Bueno\",\"doi\":\"10.1016/j.vaa.2024.03.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>To evaluate the effect of increased respiratory system resistance (R<sub>RS</sub>) on dynamic compliance (C<sub>dyn</sub>) assessed by the NM3 monitor (C<sub>dyn(NM3)</sub>) and the E-CAiOV module (C<sub>dyn(ECAiOV)</sub>).</p></div><div><h3>Study design</h3><p>Prospective laboratory study.</p></div><div><h3>Methods</h3><p>A training test lung (TTL) simulated the mechanical ventilation of a mammal with 50 and 300 mL tidal volumes in three conditions of R<sub>RS</sub> [normal (R<sub>BL</sub>), moderately increased (R<sub>1</sub>) and severely increased (R<sub>2</sub>)] and a wide range of clinically relevant C<sub>dyn</sub>. Simulations at increased R<sub>RS</sub> were paired with simulations at R<sub>BL</sub> with the same static compliance for comparisons. Pearson’s correlation coefficient and concordance correlation coefficient between the measurements at R<sub>BL</sub> with the ones with increased R<sub>RS</sub> were calculated. Bland–Altman plots were also used to evaluate the agreement of C<sub>dyn(ECAiOV)</sub> and C<sub>dyn(NM3)</sub> at R<sub>BL</sub> (control values) with their paired values at R<sub>1</sub> and R<sub>2</sub>. Relative bias and limits of agreement (LOAs) were calculated and LOAs larger than 30% were considered unacceptable. Trending ability of C<sub>dyn(NM3)</sub> and C<sub>dyn(ECAiOV)</sub> were evaluated by polar plots. Values of <em>p</em> < 0.05 were considered significant.</p></div><div><h3>Results</h3><p>The effect of increased R<sub>RS</sub> was more pronounced for C<sub>dyn(ECAiOV)</sub> than for C<sub>dyn(NM3)</sub>. Unacceptable agreement was only observed in C<sub>dyn(NM3)</sub> at R<sub>2</sub> in the 300 mL simulation (bias = –18.3% and lower LOA = –45%). For C<sub>dyn(ECAiOV)</sub>, agreement was unacceptable for all tested R<sub>RS</sub> in both simulations, being the worst at R<sub>2</sub> in the 300 mL simulation (bias = –54.7% and lower LOA = –100.2%). Both levels of increased R<sub>RS</sub> caused poor trending ability for C<sub>dyn(ECAiOV)</sub>, whereas the same effect was only observed for C<sub>dyn(NM3)</sub> at R<sub>2</sub>.</p></div><div><h3>Conclusions and clinical relevance</h3><p>In the presence of increased R<sub>RS</sub>, C<sub>dyn</sub> estimated by the NM3 monitor presented better capability to distinguish between changes in R<sub>RS</sub> from changes in respiratory system compliance.</p></div>\",\"PeriodicalId\":23626,\"journal\":{\"name\":\"Veterinary anaesthesia and analgesia\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-03-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S1467298724000357/pdfft?md5=53c3ee0552a231fb055ff80e9f31d9cc&pid=1-s2.0-S1467298724000357-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Veterinary anaesthesia and analgesia\",\"FirstCategoryId\":\"97\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1467298724000357\",\"RegionNum\":2,\"RegionCategory\":\"农林科学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"VETERINARY SCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Veterinary anaesthesia and analgesia","FirstCategoryId":"97","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1467298724000357","RegionNum":2,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"VETERINARY SCIENCES","Score":null,"Total":0}
Effect of increased resistance on dynamic compliance assessed by two clinical monitors during volume-controlled ventilation: A test-lung study
Objective
To evaluate the effect of increased respiratory system resistance (RRS) on dynamic compliance (Cdyn) assessed by the NM3 monitor (Cdyn(NM3)) and the E-CAiOV module (Cdyn(ECAiOV)).
Study design
Prospective laboratory study.
Methods
A training test lung (TTL) simulated the mechanical ventilation of a mammal with 50 and 300 mL tidal volumes in three conditions of RRS [normal (RBL), moderately increased (R1) and severely increased (R2)] and a wide range of clinically relevant Cdyn. Simulations at increased RRS were paired with simulations at RBL with the same static compliance for comparisons. Pearson’s correlation coefficient and concordance correlation coefficient between the measurements at RBL with the ones with increased RRS were calculated. Bland–Altman plots were also used to evaluate the agreement of Cdyn(ECAiOV) and Cdyn(NM3) at RBL (control values) with their paired values at R1 and R2. Relative bias and limits of agreement (LOAs) were calculated and LOAs larger than 30% were considered unacceptable. Trending ability of Cdyn(NM3) and Cdyn(ECAiOV) were evaluated by polar plots. Values of p < 0.05 were considered significant.
Results
The effect of increased RRS was more pronounced for Cdyn(ECAiOV) than for Cdyn(NM3). Unacceptable agreement was only observed in Cdyn(NM3) at R2 in the 300 mL simulation (bias = –18.3% and lower LOA = –45%). For Cdyn(ECAiOV), agreement was unacceptable for all tested RRS in both simulations, being the worst at R2 in the 300 mL simulation (bias = –54.7% and lower LOA = –100.2%). Both levels of increased RRS caused poor trending ability for Cdyn(ECAiOV), whereas the same effect was only observed for Cdyn(NM3) at R2.
Conclusions and clinical relevance
In the presence of increased RRS, Cdyn estimated by the NM3 monitor presented better capability to distinguish between changes in RRS from changes in respiratory system compliance.
期刊介绍：
Veterinary Anaesthesia and Analgesia is the official journal of the Association of Veterinary Anaesthetists, the American College of Veterinary Anesthesia and Analgesia and the European College of Veterinary Anaesthesia and Analgesia. Its purpose is the publication of original, peer reviewed articles covering all branches of anaesthesia and the relief of pain in animals. Articles concerned with the following subjects related to anaesthesia and analgesia are also welcome:
the basic sciences;
pathophysiology of disease as it relates to anaesthetic management
equipment
intensive care
chemical restraint of animals including laboratory animals, wildlife and exotic animals
welfare issues associated with pain and distress
education in veterinary anaesthesia and analgesia.
Review articles, special articles, and historical notes will also be published, along with editorials, case reports in the form of letters to the editor, and book reviews. There is also an active correspondence section.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
