背景:患者-呼吸机不同步通常发生在压力支持通气(PSV)期间。IntelliSync+软件(HamiltonMedicalAG,博纳杜兹,瑞士)是一种新的通气技术,可连续分析呼吸机波形,以实时检测患者灵感的开始和结束。本研究旨在评估IntelliSync+软件对吸气触发延迟时间的生理影响,触发阶段的三角洲气道(Paw)和食管(Pes)压降,0.1s时的气道阻塞压(P0.1),和血液动力学变量。
方法:对14例PSV机械通气患者进行了一项随机交叉生理研究。患者被随机分配接受常规流量触发和循环,吸气触发同步(I-sync),周期同步(C-sync),和吸气触发和周期同步(I/C同步)15分钟在每一步。其他呼吸机设置保持恒定。爪子,Pes,气流,P0.1,呼吸频率,记录SpO2和血液动力学变量。主要结果是每次干预之间的吸气触发和周期延迟时间。次要结果是触发阶段的ΔPaw和Pes下降,P0.1,SpO2和血液动力学变量。
结果:与基线相比,I-sync启动触发的时间明显缩短(208.9±91.7vs.301.4±131.7毫秒;P=0.002)和I/C同步与基线(222.8±94.0vs.301.4±131.7毫秒;P=0.005)。与C同步组相比,I/C同步组在触发阶段的deltaPaw和Pes下降明显较低(-0.7±0.4vs.-1.2±0.8cmH2O;P=0.028和-1.8±2.2vs.-2.8±3.2cmH2O;分别为P=0.011)。循环延迟时间无统计学差异,P0.1和组间的其他生理变量。
结论:在PSV模式下,与传统流量触发系统相比,IntelliSync+软件减少了吸气触发延迟时间。然而,使用IntelliSync+软件未观察到周期延迟时间和其他生理变量的显著改善.
背景:本研究已在泰国临床试验注册中心注册(TCTR20200528003;注册日期2020年5月28日)。
BACKGROUND: Patient-ventilator asynchrony commonly occurs during pressure support ventilation (PSV). IntelliSync + software (Hamilton Medical AG, Bonaduz, Switzerland) is a new ventilation technology that continuously analyzes ventilator waveforms to detect the beginning and end of patient inspiration in real time. This study aimed to evaluate the physiological effect of IntelliSync + software on inspiratory trigger delay time, delta airway (Paw) and esophageal (Pes) pressure drop during the trigger phase, airway occlusion pressure at 0.1 s (P0.1), and hemodynamic variables.
METHODS: A randomized crossover physiologic study was conducted in 14 mechanically ventilated patients under PSV. Patients were randomly assigned to receive conventional flow trigger and cycling, inspiratory trigger synchronization (I-sync), cycle synchronization (C-sync), and inspiratory trigger and cycle synchronization (I/C-sync) for 15 min at each step. Other ventilator settings were kept constant. Paw, Pes, airflow, P0.1, respiratory rate, SpO2, and hemodynamic variables were recorded. The primary outcome was inspiratory trigger and cycle delay time between each intervention. Secondary outcomes were delta Paw and Pes drop during the trigger phase, P0.1, SpO2, and hemodynamic variables.
RESULTS: The time to initiate the trigger was significantly shorter with I-sync compared to baseline (208.9±91.7 vs. 301.4±131.7 msec; P = 0.002) and I/C-sync compared to baseline (222.8±94.0 vs. 301.4±131.7 msec; P = 0.005). The I/C-sync group had significantly lower delta Paw and Pes drop during the trigger phase compared to C-sync group (-0.7±0.4 vs. -1.2±0.8 cmH2O; P = 0.028 and - 1.8±2.2 vs. -2.8±3.2 cmH2O; P = 0.011, respectively). No statistically significant differences were found in cycle delay time, P0.1 and other physiological variables between the groups.
CONCLUSIONS: IntelliSync + software reduced inspiratory trigger delay time compared to the conventional flow trigger system during PSV mode. However, no significant improvements in cycle delay time and other physiological variables were observed with IntelliSync + software.
BACKGROUND: This study was registered in the Thai Clinical Trial Registry (TCTR20200528003; date of registration 28/05/2020).