目的:本研究旨在使用电阻抗断层成像技术评估通气性ARDS患者坐姿后肺通气的改善情况。
方法:共有17例机械通气的ARDS患者参加了这项研究。其中中度ARDS8例,重度ARDS9例。每位患者最初都处于仰卧位(S1),过渡到坐姿(SP)30分钟,然后回到仰卧位(S2)。每个时期都对患者进行监测,记录参数。
方法:主要结果包括EIT的空间分布参数,感兴趣的区域(ROI),呼气末肺阻抗(ΔEELI),和呼吸力学参数。
结果:与S1相比,SP在ROI1中的分布显着改变(11.29±4.70vs14.88±5.00%,p=0.003)和ROI2(35.59±8.99vs44.65±6.97%,p<0.001),显示减少,而ROI3(39.71±11.49vs33.06±6.34%,p=0.009),ROI4(13.35±8.76vs7.24±5.23%,p<0.001),随着峰值吸气压力(29.24±3.96vs27.71±4.00cmH2O,p=0.036),显示增加。ΔEELI腹侧显著下降(168.3(40.33-189.5),p<0.0001),并在背侧显着增加(461.7(297.5-683.7),p<0.0001)。在坐姿30分钟后,与S1相比,S2的PaO2/FiO2比率显着改善(108(73-130)vs96(57-129)mmHg,p=0.03)。
结论:坐姿与依从性增强有关,改善氧合,与仰卧位相比,通气性ARDS患者的通气更均匀。
结论:了解体位变化对患者肺通气的影响,以规范危重患者的安全做法是很重要的。这可能有助于通气患者的管理。
OBJECTIVE: The study aimed to evaluate the improvements in pulmonary ventilation following a sitting position in ventilated ARDS patients using electrical impedance tomography.
METHODS: 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.
METHODS: 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.
CONCLUSIONS: 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.