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首页> 外文期刊>The Internet Journal of Pulmonary Medicine >The Effect Of Varying Inspiratory Flow Waveforms On Alveolar Peak Airway Pressure And Intrinsic Positive End Expiratory Pressure In Mechanically Ventilated Patients
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The Effect Of Varying Inspiratory Flow Waveforms On Alveolar Peak Airway Pressure And Intrinsic Positive End Expiratory Pressure In Mechanically Ventilated Patients

机译：机械通气患者吸气流量波形变化对肺泡峰值气道压力和内在正向呼气压力的影响

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Purpose: To prospectively evaluate peak airway pressure (PaW) intrinsic PEEP (PEEPi), extrinsic PEEP (PEEPe) and peak expiratory flow rate (PEFR) with changing inspiratory flow waveforms during mechanical ventilation in patients.Material And Methods: Ten critically ill mechanically ventilated patients on controlled mechanical ventilation (CMV) with acute respiratory failure admitted to the intensive care unit were evaluated to assess the effects of decelerating, square and sine waveforms on). PaW, PEEPi, PEEPe, PEFR Results: PaW was lower with the decelerating waveform compared to square and sine There was no statistical difference in PEEPi, PEEPe or PEFR with varying inspiratory flow waveforms..Conclusions: Adjustment of inspiratory flow waveforms does not affect PEEPi. A lower PaW coupled with a stable PEEPi makes the decelerating waveform preferred for mechanically ventilated critically ill patients on CMV. Introduction Clinicians have become increasingly aware of the importance of delivering effective mechanical ventilation while trying to avoid injury associated with different modes. Research has examined untoward effects of certain variables of mechanical ventilation including tidal volume (Vt), intrinsic and extrinsic positive end expiratory pressure (PEEPi and PEEPe) and respiratory rate (RR) (1,2,3,4,5,6). Air trapping and breath stacking often cause development of an increased PEEPi, adverse effects include: altered mechanical ventilation measured variables, hemodynamic compromise, misreading of central venous and pulmonary artery catheter pressure measurements. Other effects are erroneous calculations of static respiratory compliance and increases in work of breathing, which could delay weaning from the ventilator. (7,8,9,10,11,12,13,14) Less obviously, the effect of pressure variation of the inspiratory waveform has been implicated in shear stress damage at the alveolar and lung parenchymal level possibly resulting in a cytokine cascade capable of damaging other organ systems.Modeling of the lung as a simple electrical capacitance to simulate lung compliance and an electrical resistance as an analog for airway resistance (15) (Fig1) indicates that, at lower respiratory frequencies, levels of PEEPi sould be independent of the applied inspiratory waveform. The integrating properties of the compliance and resistance should, theoretically, achieve the same peak inspiratory pressure and PEEPi as long as Vt is the same, and expiratory time is sufficient to prevent breath trapping. This might suggests that the inspiratory waveform should confer no therapeutic advantage with respect to PaW and PEEPi.
机译：目的：前瞻性评估患者机械通气过程中的呼气流量波形变化，评估气道内压峰值（PaW）固有PEEP（PEEPi），外在PEEP（PEEPe）和呼气峰值流速（PEFR）。材料和方法：十例重症机械通气对接受重症监护病房的患有急性呼吸衰竭的机械通气（CMV）的患者进行评估，以评估减速，方波和正弦波对其的影响。 PaW，PEEPi，PEEPe，PEFR结果：与方波和正弦波相比，减速波形下的PaW较低。PEEPi，PEEPe或PEFR随吸气流量波形的变化无统计学差异。结论：吸气流量波形的调整不会影响PEEPi 。较低的PaW加上稳定的PEEPi，使减速波形成为CMV机械通气危重患者的首选。简介临床医生越来越意识到提供有效的机械通气，同时避免与不同模式相关的伤害的重要性。研究已经检查了某些机械通气变量的不利影响，包括潮气量（Vt），内在和外在正呼气末压（PEEPi和PEEPe）和呼吸频率（RR）（1,2,3,4,5,6）。空气滞留和呼吸堆积通常会导致PEEPi升高，不利影响包括：机械通气测量变量改变，血液动力学损害，中心静脉和肺动脉导管压力测量值误读。其他影响包括静态呼吸顺应性的错误计算以及呼吸功的增加，这可能会延迟从呼吸机断奶。 （7,8,9,10,11,12,13,14）不太明显的是，吸气波形压力变化的影响与肺泡和肺实质水平的剪切应力损伤有关，可能导致细胞因子级联肺部建模为模拟肺顺应性的简单电容，肺部建模为气道阻力的类似物（15）（图1）表明，在较低的呼吸频率下，PEEPi的水平独立于应用的吸气波形。理论上，只要Vt相同，顺应性和阻力的积分特性应达到相同的峰值吸气压力和PEEPi，并且呼气时间足以防止呼吸困滞。这可能表明吸气波形在PaW和PEEPi方面无治疗优势。

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