PDF(Pubmed)
Abstract：
Although patients with interstitial pneumonia pattern (ILD-UIP) and acute exacerbation (AE) leading to severe acute respiratory failure may require invasive mechanical ventilation (MV), physiological data on lung mechanics during MV are lacking. We aimed at describing the physiological effect of lung-protective ventilation in patients with AE-ILD-UIP compared with primary ARDS.
Partitioned lung and chest wall mechanics were assessed in a series of AE-ILD-UIP patients matched 1:1 with primary ARDS as controls (based on BMI and PaO2/FiO2 ratio). Three PEEP levels (zero = ZEEP, 4-8 cmH2O = PEEPLOW, and titrated to achieve positive end-expiratory transpulmonary pressure PL,EE = PEEPTITRATED) were used for measurements.
Ten AE-ILD-UIP patients and 10 matched ARDS were included. In AE-ILD-UIP median PL,EE at ZEEP was - 4.3 [- 7.6- - 2.3] cmH2O and lung elastance (EL) 44 [40-51] cmH2O/L. At PEEPLOW, PL,EE remained negative and EL did not change (p = 0.995) versus ZEEP. At PEEPTITRATED, PL,EE increased to 0.8 [0.3-1.5] cmH2O and EL to 49 [43-59] (p = 0.004 and p < 0.001 compared to ZEEP and PEEPLOW, respectively). ΔPL decreased at PEEPLOW (p = 0.018) and increased at PEEPTITRATED (p = 0.003). In matched ARDS control PEEP titration to obtain a positive PL,EE did not result in significant changes in EL and ΔPL.
In mechanically ventilated AE-ILD-UIP patients, differently than in patients with primary ARDS, PEEP titrated to obtain a positive PL,EE significantly worsened lung mechanics.
Partitioned lung and chest wall mechanics were assessed in a series of AE-ILD-UIP patients matched 1:1 with primary ARDS as controls (based on BMI and PaO2/FiO2 ratio). Three PEEP levels (zero = ZEEP, 4-8 cmH2O = PEEPLOW, and titrated to achieve positive end-expiratory transpulmonary pressure PL,EE = PEEPTITRATED) were used for measurements.
Ten AE-ILD-UIP patients and 10 matched ARDS were included. In AE-ILD-UIP median PL,EE at ZEEP was - 4.3 [- 7.6- - 2.3] cmH2O and lung elastance (EL) 44 [40-51] cmH2O/L. At PEEPLOW, PL,EE remained negative and EL did not change (p = 0.995) versus ZEEP. At PEEPTITRATED, PL,EE increased to 0.8 [0.3-1.5] cmH2O and EL to 49 [43-59] (p = 0.004 and p < 0.001 compared to ZEEP and PEEPLOW, respectively). ΔPL decreased at PEEPLOW (p = 0.018) and increased at PEEPTITRATED (p = 0.003). In matched ARDS control PEEP titration to obtain a positive PL,EE did not result in significant changes in EL and ΔPL.
In mechanically ventilated AE-ILD-UIP patients, differently than in patients with primary ARDS, PEEP titrated to obtain a positive PL,EE significantly worsened lung mechanics.
摘要：
背景：尽管间质性肺炎（ILD-UIP）和急性加重（AE）导致严重急性呼吸衰竭的患者可能需要有创机械通气（MV），缺乏MV期间肺力学的生理数据。我们旨在描述与原发性ARDS相比，AE-ILD-UIP患者肺保护性通气的生理作用。
方法：在一系列AE-ILD-UIP患者中以1：1匹配的原发性ARDS作为对照（基于BMI和PaO2/FiO2比率）中，对肺和胸壁力学进行了评估。三个PEEP等级(零=ZEEP,4-8cmH2O=PEEPLOW,并滴定以达到呼气末正压PL，EE=PEPECTITRATED)用于测量。
结果：包括10例AE-ILD-UIP患者和10例匹配的ARDS患者。在AE-ILD-UIP中，在ZEEP时的EE为-4.3[-7.6--2.3]cmH2O和肺弹性(EL)44[40-51]cmH2O/L。在PEEPLOW,PL,EE保持阴性，EL与ZEEP相比没有变化（p=0.995）。在PEPTATRATED,PL,EE增加到0.8[0.3-1.5]cmH2O，EL增加到49[43-59]（p=0.004，p<0.001，与ZEEP和PEEPLOW相比，分别)。ΔPL在PEEPLOW时降低(p=0.018),在PEETTATED时升高(p=0.003)。在匹配的ARDS对照PEEP滴定以获得阳性PL，EE没有导致EL和ΔPL的显著变化。
结论：在机械通气的AE-ILD-UIP患者中，与原发性ARDS患者不同，滴定PEEP以获得阳性PL，EE显着恶化了肺力学。
方法：在一系列AE-ILD-UIP患者中以1：1匹配的原发性ARDS作为对照（基于BMI和PaO2/FiO2比率）中，对肺和胸壁力学进行了评估。三个PEEP等级(零=ZEEP,4-8cmH2O=PEEPLOW,并滴定以达到呼气末正压PL，EE=PEPECTITRATED)用于测量。
结果：包括10例AE-ILD-UIP患者和10例匹配的ARDS患者。在AE-ILD-UIP中，在ZEEP时的EE为-4.3[-7.6--2.3]cmH2O和肺弹性(EL)44[40-51]cmH2O/L。在PEEPLOW,PL,EE保持阴性，EL与ZEEP相比没有变化（p=0.995）。在PEPTATRATED,PL,EE增加到0.8[0.3-1.5]cmH2O，EL增加到49[43-59]（p=0.004，p<0.001，与ZEEP和PEEPLOW相比，分别)。ΔPL在PEEPLOW时降低(p=0.018),在PEETTATED时升高(p=0.003)。在匹配的ARDS对照PEEP滴定以获得阳性PL，EE没有导致EL和ΔPL的显著变化。
结论：在机械通气的AE-ILD-UIP患者中，与原发性ARDS患者不同，滴定PEEP以获得阳性PL，EE显着恶化了肺力学。
