通过同步电阻抗断层扫描和跨肺压力监测为急性呼吸窘迫综合征自主呼吸患者提供个性化呼气末正压:随机交叉试验

IF 27.1 1区 医学 Q1 CRITICAL CARE MEDICINE Intensive Care Medicine Pub Date : 2024-11-11 DOI:10.1007/s00134-024-07695-y
Tommaso Mauri, Domenico L. Grieco, Elena Spinelli, Marco Leali, Joaquin Perez, Valentina Chiavieri, Tommaso Rosà, Pierluigi Ferrara, Gaetano Scaramuzzo, Massimo Antonelli, Savino Spadaro, Giacomo Grasselli
{"title":"通过同步电阻抗断层扫描和跨肺压力监测为急性呼吸窘迫综合征自主呼吸患者提供个性化呼气末正压:随机交叉试验","authors":"Tommaso Mauri, Domenico L. Grieco, Elena Spinelli, Marco Leali, Joaquin Perez, Valentina Chiavieri, Tommaso Rosà, Pierluigi Ferrara, Gaetano Scaramuzzo, Massimo Antonelli, Savino Spadaro, Giacomo Grasselli","doi":"10.1007/s00134-024-07695-y","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Personalized positive end-expiratory pressure (PEEP) might foster lung and diaphragm protection in patients with acute respiratory distress syndrome (ARDS) who are undergoing pressure support ventilation (PSV). We aimed to compare the physiologic effects of personalized PEEP set according to synchronized electrical impedance tomography (EIT) and driving transpulmonary pressure (∆PL) monitoring against a classical lower PEEP/FiO<sub>2</sub> table in intubated ARDS patients undergoing PSV.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A cross-over randomized multicenter study was conducted in 30 ARDS patients with simultaneous recording of the airway, esophageal and transpulmonary pressure, together with EIT during PSV. Following a decremental PEEP trial (18 cmH<sub>2</sub>O to 4 cmH<sub>2</sub>O), PEEP<sub>EIT-∆PL</sub> was identified as the level with the smallest difference between lung overdistension and collapse. A low PEEP/FiO<sub>2</sub> table was used to select PEEP<sub>TABLE</sub>. Each PEEP strategy was applied for 20 min, and physiologic data were collected at the end of each step.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The PEEP trial was well tolerated. Median PEEP<sub>EIT-∆PL</sub> was higher than PEEP<sub>TABLE</sub> (10 [8–12] vs. 8 [5–10] cmH<sub>2</sub>O; <i>P</i> = 0.021) and, at the individual patient level, PEEP<sub>EIT-∆PL</sub> level differed from PEEP<sub>TABLE</sub> in all patients. Overall, PEEP<sub>EIT-∆PL</sub> was associated with lower dynamic ∆PL (<i>P</i> &lt; 0.001) and pressure–time product (<i>P</i> &lt; 0.001), but there was variability among patients. PEEP<sub>EIT-∆PL</sub> also decreased respiratory drive and effort (<i>P</i> &lt; 0.001), improved regional lung mechanics (<i>P</i> &lt; 0.05) and reversed lung collapse (<i>P</i> = 0.007) without increasing overdistension (<i>P</i> = 0.695).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Personalized PEEP selected using synchronized EIT and transpulmonary pressure monitoring could be associated with reduced dynamic lung stress and metabolic work of breathing in ARDS patients undergoing PSV.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":null,"pages":null},"PeriodicalIF":27.1000,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Personalized positive end-expiratory pressure in spontaneously breathing patients with acute respiratory distress syndrome by simultaneous electrical impedance tomography and transpulmonary pressure monitoring: a randomized crossover trial\",\"authors\":\"Tommaso Mauri, Domenico L. Grieco, Elena Spinelli, Marco Leali, Joaquin Perez, Valentina Chiavieri, Tommaso Rosà, Pierluigi Ferrara, Gaetano Scaramuzzo, Massimo Antonelli, Savino Spadaro, Giacomo Grasselli\",\"doi\":\"10.1007/s00134-024-07695-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Purpose</h3><p>Personalized positive end-expiratory pressure (PEEP) might foster lung and diaphragm protection in patients with acute respiratory distress syndrome (ARDS) who are undergoing pressure support ventilation (PSV). We aimed to compare the physiologic effects of personalized PEEP set according to synchronized electrical impedance tomography (EIT) and driving transpulmonary pressure (∆PL) monitoring against a classical lower PEEP/FiO<sub>2</sub> table in intubated ARDS patients undergoing PSV.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>A cross-over randomized multicenter study was conducted in 30 ARDS patients with simultaneous recording of the airway, esophageal and transpulmonary pressure, together with EIT during PSV. Following a decremental PEEP trial (18 cmH<sub>2</sub>O to 4 cmH<sub>2</sub>O), PEEP<sub>EIT-∆PL</sub> was identified as the level with the smallest difference between lung overdistension and collapse. A low PEEP/FiO<sub>2</sub> table was used to select PEEP<sub>TABLE</sub>. Each PEEP strategy was applied for 20 min, and physiologic data were collected at the end of each step.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>The PEEP trial was well tolerated. Median PEEP<sub>EIT-∆PL</sub> was higher than PEEP<sub>TABLE</sub> (10 [8–12] vs. 8 [5–10] cmH<sub>2</sub>O; <i>P</i> = 0.021) and, at the individual patient level, PEEP<sub>EIT-∆PL</sub> level differed from PEEP<sub>TABLE</sub> in all patients. Overall, PEEP<sub>EIT-∆PL</sub> was associated with lower dynamic ∆PL (<i>P</i> &lt; 0.001) and pressure–time product (<i>P</i> &lt; 0.001), but there was variability among patients. PEEP<sub>EIT-∆PL</sub> also decreased respiratory drive and effort (<i>P</i> &lt; 0.001), improved regional lung mechanics (<i>P</i> &lt; 0.05) and reversed lung collapse (<i>P</i> = 0.007) without increasing overdistension (<i>P</i> = 0.695).</p><h3 data-test=\\\"abstract-sub-heading\\\">Conclusion</h3><p>Personalized PEEP selected using synchronized EIT and transpulmonary pressure monitoring could be associated with reduced dynamic lung stress and metabolic work of breathing in ARDS patients undergoing PSV.</p>\",\"PeriodicalId\":13665,\"journal\":{\"name\":\"Intensive Care Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":27.1000,\"publicationDate\":\"2024-11-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Intensive Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00134-024-07695-y\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Intensive Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00134-024-07695-y","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0

摘要

目的个性化呼气末正压(PEEP)可促进正在接受压力支持通气(PSV)的急性呼吸窘迫综合征(ARDS)患者的肺和膈肌保护。我们的目的是在接受 PSV 的插管 ARDS 患者中,比较根据同步电阻抗断层扫描(EIT)和肺动脉转压(ΔPL)监测设定的个性化 PEEP 与传统的较低 PEEP/FiO2 表的生理效果。方法在 30 名 ARDS 患者中开展了一项交叉随机多中心研究,在 PSV 期间同时记录气道、食道和肺动脉转压以及 EIT。经过递减 PEEP 试验(18 cmH2O 至 4 cmH2O),确定 PEEPEIT-∆PL 为肺过度张力与塌陷之间差异最小的水平。使用低 PEEP/FiO2 表选择 PEEPTABLE。每种 PEEP 策略应用 20 分钟,并在每个步骤结束时收集生理数据。中位 PEEPEIT-∆PL 高于 PEEPTABLE(10 [8-12] vs. 8 [5-10] cmH2O;P = 0.021),在患者个体水平上,所有患者的 PEEPEIT-∆PL 水平均不同于 PEEPTABLE。总体而言,PEEPEIT-∆PL 与较低的动态∆PL(P < 0.001)和压力-时间乘积(P < 0.001)相关,但患者之间存在差异。结论使用同步 EIT 和跨肺压力监测选择个性化 PEEP 可降低接受 PSV 治疗的 ARDS 患者的动态肺压力和呼吸代谢功。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

摘要图片

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Personalized positive end-expiratory pressure in spontaneously breathing patients with acute respiratory distress syndrome by simultaneous electrical impedance tomography and transpulmonary pressure monitoring: a randomized crossover trial

Purpose

Personalized positive end-expiratory pressure (PEEP) might foster lung and diaphragm protection in patients with acute respiratory distress syndrome (ARDS) who are undergoing pressure support ventilation (PSV). We aimed to compare the physiologic effects of personalized PEEP set according to synchronized electrical impedance tomography (EIT) and driving transpulmonary pressure (∆PL) monitoring against a classical lower PEEP/FiO2 table in intubated ARDS patients undergoing PSV.

Methods

A cross-over randomized multicenter study was conducted in 30 ARDS patients with simultaneous recording of the airway, esophageal and transpulmonary pressure, together with EIT during PSV. Following a decremental PEEP trial (18 cmH2O to 4 cmH2O), PEEPEIT-∆PL was identified as the level with the smallest difference between lung overdistension and collapse. A low PEEP/FiO2 table was used to select PEEPTABLE. Each PEEP strategy was applied for 20 min, and physiologic data were collected at the end of each step.

Results

The PEEP trial was well tolerated. Median PEEPEIT-∆PL was higher than PEEPTABLE (10 [8–12] vs. 8 [5–10] cmH2O; P = 0.021) and, at the individual patient level, PEEPEIT-∆PL level differed from PEEPTABLE in all patients. Overall, PEEPEIT-∆PL was associated with lower dynamic ∆PL (P < 0.001) and pressure–time product (P < 0.001), but there was variability among patients. PEEPEIT-∆PL also decreased respiratory drive and effort (P < 0.001), improved regional lung mechanics (P < 0.05) and reversed lung collapse (P = 0.007) without increasing overdistension (P = 0.695).

Conclusion

Personalized PEEP selected using synchronized EIT and transpulmonary pressure monitoring could be associated with reduced dynamic lung stress and metabolic work of breathing in ARDS patients undergoing PSV.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Intensive Care Medicine
Intensive Care Medicine 医学-危重病医学
CiteScore
51.50
自引率
2.80%
发文量
326
审稿时长
1 months
期刊介绍: Intensive Care Medicine is the premier publication platform fostering the communication and exchange of cutting-edge research and ideas within the field of intensive care medicine on a comprehensive scale. Catering to professionals involved in intensive medical care, including intensivists, medical specialists, nurses, and other healthcare professionals, ICM stands as the official journal of The European Society of Intensive Care Medicine. ICM is dedicated to advancing the understanding and practice of intensive care medicine among professionals in Europe and beyond. The journal provides a robust platform for disseminating current research findings and innovative ideas in intensive care medicine. Content published in Intensive Care Medicine encompasses a wide range, including review articles, original research papers, letters, reviews, debates, and more.
期刊最新文献
Air pollutant exposure and mortality risk of critically ill patients Beta-blockers as antiarrhythmics in septic shock: a light at the end of the tunnel? Chlorhexidine-alcohol compared with povidone-iodine-alcohol skin antisepsis protocols in major cardiac surgery: a randomized clinical trial Sepsis: key insights, future directions, and immediate goals. A review and expert opinion Personalized positive end-expiratory pressure in spontaneously breathing patients with acute respiratory distress syndrome by simultaneous electrical impedance tomography and transpulmonary pressure monitoring: a randomized crossover trial
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1