Xiaofeng Chen , Ruyang Xiong , Ming Zhang , Chunming Guan , Liwei Feng , Zhipeng Yao , Yue Li , Wenhua Liu , Ming Ye , Yunlong Li , Xuesong Jiang , Yonglin Tang , Hongliang Wang , Junbo Zheng
{"title":"坐姿对通过电阻抗断层扫描测定的 ARDS 通气分布的影响。","authors":"Xiaofeng Chen , Ruyang Xiong , Ming Zhang , Chunming Guan , Liwei Feng , Zhipeng Yao , Yue Li , Wenhua Liu , Ming Ye , Yunlong Li , Xuesong Jiang , Yonglin Tang , Hongliang Wang , Junbo Zheng","doi":"10.1016/j.iccn.2024.103782","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>The study aimed to evaluate the improvements in pulmonary ventilation following a sitting position in ventilated ARDS patients using electrical impedance tomography.</p></div><div><h3>Methodology</h3><p>A total of 17 patients with ARDS under mechanical ventilation participated in this study, including 8 with moderate ARDS and 9 with severe ARDS. Each patient was initially placed in the supine position (S1), transitioned to sitting position (SP) for 30 min, and then returned to the supine position (S2). Patients were monitored for each period, with parameters recorded.</p></div><div><h3>Main Outcome measures</h3><p>The primary outcome included the spatial distribution parameters of EIT, regional of interest (ROI), end-expiratory lung impedance (ΔEELI), and parameters of respiratory mechanics.</p></div><div><h3>Results</h3><p>Compared to S1, the SP significantly altered the distribution in ROI1 (11.29 ± 4.70 vs 14.88 ± 5.00 %, p = 0.003) and ROI2 (35.59 ± 8.99 vs 44.65 ± 6.97 %, p ＜ 0.001), showing reductions, while ROI3 (39.71 ± 11.49 vs 33.06 ± 6.34 %, p = 0.009), ROI4 (13.35 ± 8.76 vs 7.24 ± 5.23 %, p ＜ 0.001), along with peak inspiratory pressure (29.24 ± 3.96 vs 27.71 ± 4.00 cmH<sub>2</sub>O, p = 0.036), showed increases. ΔEELI decreased significantly ventrally (168.3 (40.33 – 189.5), p ＜ 0.0001) and increased significantly dorsally (461.7 (297.5 – 683.7), p ＜ 0.0001). The PaO<sub>2</sub>/FiO<sub>2</sub> ratio saw significant improvement in S2 compared to S1 after 30 min in the seated position (108 (73 – 130) vs 96 (57 – 129) mmHg, p = 0.03).</p></div><div><h3>Conclusions</h3><p>The sitting position is associated with enhanced compliance, improved oxygenation, and more homogenous ventilation in patients with ventilated ARDS compared to the supine position.</p></div><div><h3>Implications for Clinical Practice</h3><p>It is important to know the impact of postural changes on patient pulmonary ventilation in order to standardize safe practices in critically ill patients. It may be helpful in the management among ventilated patients.</p></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"85 ","pages":"Article 103782"},"PeriodicalIF":4.9000,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0964339724001678/pdfft?md5=b9fe7a444109b0f9405f81f0d490f2af&pid=1-s2.0-S0964339724001678-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Effects of sitting position on ventilation distribution determined by electrical impedance tomography in ventilated ARDS patients\",\"authors\":\"Xiaofeng Chen , Ruyang Xiong , Ming Zhang , Chunming Guan , Liwei Feng , Zhipeng Yao , Yue Li , Wenhua Liu , Ming Ye , Yunlong Li , Xuesong Jiang , Yonglin Tang , Hongliang Wang , Junbo Zheng\",\"doi\":\"10.1016/j.iccn.2024.103782\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>The study aimed to evaluate the improvements in pulmonary ventilation following a sitting position in ventilated ARDS patients using electrical impedance tomography.</p></div><div><h3>Methodology</h3><p>A total of 17 patients with ARDS under mechanical ventilation participated in this study, including 8 with moderate ARDS and 9 with severe ARDS. Each patient was initially placed in the supine position (S1), transitioned to sitting position (SP) for 30 min, and then returned to the supine position (S2). Patients were monitored for each period, with parameters recorded.</p></div><div><h3>Main Outcome measures</h3><p>The primary outcome included the spatial distribution parameters of EIT, regional of interest (ROI), end-expiratory lung impedance (ΔEELI), and parameters of respiratory mechanics.</p></div><div><h3>Results</h3><p>Compared to S1, the SP significantly altered the distribution in ROI1 (11.29 ± 4.70 vs 14.88 ± 5.00 %, p = 0.003) and ROI2 (35.59 ± 8.99 vs 44.65 ± 6.97 %, p ＜ 0.001), showing reductions, while ROI3 (39.71 ± 11.49 vs 33.06 ± 6.34 %, p = 0.009), ROI4 (13.35 ± 8.76 vs 7.24 ± 5.23 %, p ＜ 0.001), along with peak inspiratory pressure (29.24 ± 3.96 vs 27.71 ± 4.00 cmH<sub>2</sub>O, p = 0.036), showed increases. ΔEELI decreased significantly ventrally (168.3 (40.33 – 189.5), p ＜ 0.0001) and increased significantly dorsally (461.7 (297.5 – 683.7), p ＜ 0.0001). The PaO<sub>2</sub>/FiO<sub>2</sub> ratio saw significant improvement in S2 compared to S1 after 30 min in the seated position (108 (73 – 130) vs 96 (57 – 129) mmHg, p = 0.03).</p></div><div><h3>Conclusions</h3><p>The sitting position is associated with enhanced compliance, improved oxygenation, and more homogenous ventilation in patients with ventilated ARDS compared to the supine position.</p></div><div><h3>Implications for Clinical Practice</h3><p>It is important to know the impact of postural changes on patient pulmonary ventilation in order to standardize safe practices in critically ill patients. It may be helpful in the management among ventilated patients.</p></div>\",\"PeriodicalId\":51322,\"journal\":{\"name\":\"Intensive and Critical Care Nursing\",\"volume\":\"85 \",\"pages\":\"Article 103782\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2024-08-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S0964339724001678/pdfft?md5=b9fe7a444109b0f9405f81f0d490f2af&pid=1-s2.0-S0964339724001678-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Intensive and Critical Care Nursing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0964339724001678\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Intensive and Critical Care Nursing","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0964339724001678","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
Effects of sitting position on ventilation distribution determined by electrical impedance tomography in ventilated ARDS patients
Objective
The study aimed to evaluate the improvements in pulmonary ventilation following a sitting position in ventilated ARDS patients using electrical impedance tomography.
Methodology
A total of 17 patients with ARDS under mechanical ventilation participated in this study, including 8 with moderate ARDS and 9 with severe ARDS. Each patient was initially placed in the supine position (S1), transitioned to sitting position (SP) for 30 min, and then returned to the supine position (S2). Patients were monitored for each period, with parameters recorded.
Main Outcome measures
The primary outcome included the spatial distribution parameters of EIT, regional of interest (ROI), end-expiratory lung impedance (ΔEELI), and parameters of respiratory mechanics.
Results
Compared to S1, the SP significantly altered the distribution in ROI1 (11.29 ± 4.70 vs 14.88 ± 5.00 %, p = 0.003) and ROI2 (35.59 ± 8.99 vs 44.65 ± 6.97 %, p ＜ 0.001), showing reductions, while ROI3 (39.71 ± 11.49 vs 33.06 ± 6.34 %, p = 0.009), ROI4 (13.35 ± 8.76 vs 7.24 ± 5.23 %, p ＜ 0.001), along with peak inspiratory pressure (29.24 ± 3.96 vs 27.71 ± 4.00 cmH2O, p = 0.036), showed increases. ΔEELI decreased significantly ventrally (168.3 (40.33 – 189.5), p ＜ 0.0001) and increased significantly dorsally (461.7 (297.5 – 683.7), p ＜ 0.0001). The PaO2/FiO2 ratio saw significant improvement in S2 compared to S1 after 30 min in the seated position (108 (73 – 130) vs 96 (57 – 129) mmHg, p = 0.03).
Conclusions
The sitting position is associated with enhanced compliance, improved oxygenation, and more homogenous ventilation in patients with ventilated ARDS compared to the supine position.
Implications for Clinical Practice
It is important to know the impact of postural changes on patient pulmonary ventilation in order to standardize safe practices in critically ill patients. It may be helpful in the management among ventilated patients.
期刊介绍：
The aims of Intensive and Critical Care Nursing are to promote excellence of care of critically ill patients by specialist nurses and their professional colleagues; to provide an international and interdisciplinary forum for the publication, dissemination and exchange of research findings, experience and ideas; to develop and enhance the knowledge, skills, attitudes and creative thinking essential to good critical care nursing practice. The journal publishes reviews, updates and feature articles in addition to original papers and significant preliminary communications. Articles may deal with any part of practice including relevant clinical, research, educational, psychological and technological aspects.
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