■食管压力(Pes)已被用作胸膜压力(Ppl)的替代指标,以滴定急性呼吸窘迫综合征(ARDS)患者的呼气末正压(PEEP)。Pes和PEEP之间的关系仍未确定。
■在接受有创机械通气的中度至重度ARDS患者中,插入带有球囊导管的胃管以监测Pes。评估呼气末Pes反应(ΔPes)对PEEP变化(ΔPEEP),PEEP水平降低,随后升高(平均变化为3cmH2O)。患者进行了以下两个系列的PEEP调整:(I)从PEEP-3cmH2O到PEEPbaseline;(II)从PEEPbaseline到PEEP3cmH2O。如果患者的ΔPes≥30%ΔPEEP,则将其分类为“PEEP依赖型”,否则将其分类为“PEEP非依赖型”(在任何系列中,ΔPes<30%ΔPEEP)。
■总共,对18例ARDS患者进行了54系列PEEP调整。在这些病人中,12人被归类为PEEP依赖型,6个被归类为PEEP非依赖性类型。在PEEP调整期间,呼气末Pes在PEEP依赖患者中发生显着变化,谁的得分为10.8(7.9,12.3),12.5(10.5,14.9),和14.5(13.1,18.3)cmH2O在PEEP-3cmH2O,PEEPbaseline,和PEEP+3cmH2O,分别(中位数和四分位数;P<0.0001),而呼气末跨肺压(PL)保持在最佳范围[-0.1(-0.7,0.4),0.1(-0.6,0.5),和0.3(-0.3,0.7)cmH2O,分别]。在PEEP独立患者中,Pes保持不变,Pes为15.4(11.4,17.8),15.5(11.6,17.8),和15.4(11.7,18.30)cmH2O在三个PEEP水平的每一个,分别。同时,呼气末PL显着改善[从PEEP-3cmH2O的-5.5(-8.5,-3.4)到PEEP基线的-2.5(-5.0,-1.6)到PEEP3cmH2O的-0.5(-1.8,0.3);P<0.01]。
■根据ΔPes至ΔPEEP鉴定了两种类型的Pes表型。潜在的机制和对临床实践的影响需要进一步探索。
UNASSIGNED: Esophageal pressure (Pes) has been used as a surrogate of pleural pressure (Ppl) to titrate positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS) patients. The relationship between Pes and PEEP remains undetermined.
UNASSIGNED: A gastric tube with a balloon catheter was inserted to monitor Pes in moderate to severe ARDS patients who underwent invasive mechanical ventilation. To assess the end-expiratory Pes response (ΔPes) to PEEP changes (ΔPEEP), the PEEP level was decreased and increased subsequently (with an average change of 3 cmH2O). The patients underwent the following two series of PEEP adjustment: (I) from PEEP-3 cmH2O to PEEPbaseline; and (II) from PEEPbaseline to PEEP+3 cmH2O. The patients were classified as \"PEEP-dependent type\" if they had ΔPes ≥30% ΔPEEP and were otherwise classified as \"PEEP-independent type\" (ΔPes <30% ΔPEEP in any series).
UNASSIGNED: In total, 54 series of PEEP adjustments were performed in 18 ARDS patients. Of these patients, 12 were classified as PEEP-dependent type, and six were classified as PEEP-independent type. During the PEEP adjustment, end-expiratory Pes changed significantly in the PEEP-dependent patients, who had a Pes of 10.8 (7.9, 12.3), 12.5 (10.5, 14.9), and 14.5 (13.1, 18.3) cmH2O at PEEP-3 cmH2O, PEEPbaseline, and PEEP+3 cmH2O, respectively (median and quartiles; P<0.0001), while end-expiratory transpulmonary pressure (PL) was maintained at an optimal range [-0.1 (-0.7, 0.4), 0.1 (-0.6, 0.5), and 0.3 (-0.3, 0.7) cmH2O, respectively]. In the PEEP-independent patients, the Pes remained unchanged, with a Pes of 15.4 (11.4, 17.8), 15.5 (11.6, 17.8), and 15.4 (11.7, 18.30) cmH2O at each of the three PEEP levels, respectively. Meanwhile, end-expiratory PL significantly improved [from -5.5 (-8.5, -3.4) at PEEP-3 cmH2O to -2.5 (-5.0, -1.6) at PEEPbaseline to -0.5 (-1.8, 0.3) at PEEP+3 cmH2O; P<0.01].
UNASSIGNED: Two types of Pes phenotypes were identified according to the ΔPes to ΔPEEP. The underlying mechanisms and implications for clinical practice require further exploration.