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首页> 外文期刊>Critical care medicine >Matching positive end-expiratory pressure to intra-abdominal pressure prevents end-expiratory lung volume decline in a pig model of intra-abdominal hypertension
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Matching positive end-expiratory pressure to intra-abdominal pressure prevents end-expiratory lung volume decline in a pig model of intra-abdominal hypertension

机译：将呼气末正压与腹内压力相匹配可防止在腹内高压猪模型中呼气末肺体积下降

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Objective: Intra-abdominal hypertension is common in critically ill patients and is associated with increased morbidity and mortality. In a previous experimental study, positive end-expiratory pressures of up to 15 cm H 2O did not prevent end-expiratory lung volume decline caused by intra-abdominal hypertension. Therefore, we examined the effect of matching positive end-expiratory pressure to the intra-abdominal pressure on cardio-respiratory parameters. Design: Experimental pig model of intra-abdominal hypertension. Setting: Large animal facility, University of Western Australia. Subjects: Nine anesthetized, nonparalyzed, and ventilated pigs (48 ± 7 kg). Interventions: Four levels of intra-abdominal pressure (baseline, 12, 18, and 22 mm Hg) were generated in a randomized order by inflating an intra-abdominal balloon. At each level of intra-abdominal pressure, three levels of positive end-expiratory pressure were randomly applied with varying degrees of matching the corresponding intra-abdominal pressure: baseline positive end-expiratory pressure (= 5 cm H 2O), moderate positive end-expiratory pressure (= half intra-abdominal pressure in cm H 2O + 5 cm H 2O), and high positive end-expiratory pressure (= intra-abdominal pressure in cm H 2O). Measurements: We measured end-expiratory lung volume, arterial oxygen levels, respiratory mechanics, and cardiac output 5 mins after each new intra-abdominal pressure and positive end-expiratory pressure setting. Main Results: Intra-abdominal hypertension decreased end-expiratory lung volume and PaO2 (-49% [p .001] and-8% [p .05], respectively, at 22 mm Hg intra-abdominal pressure compared with baseline intra-abdominal pressure) but did not change cardiac output (p = .5). At each level of intra-abdominal pressure, moderate positive end-expiratory pressure increased end-expiratory lung volume (+119% [p .001] at 22 mm Hg intra-abdominal pressure compared with 5 cm H 2O positive end-expiratory pressure) while minimally decreasing cardiac output (-8%, p .05). High positive end-expiratory pressure further increased end-expiratory lung volume (+233% [p .001] at 22 mm Hg intra-abdominal pressure compared with 5 cm H 2O positive end-expiratory pressure) but led to a greater decrease in cardiac output (-26%, p .05). Neither moderate nor high positive end-expiratory pressure improved PaO2 (p = .7).Intra-abdominal hypertension decreased end-expiratory transpulmonary pressure but did not alter end-inspiratory transpulmonary pressure. Intra-abdominal hypertension decreased total respiratory compliance through a decrease in chest wall compliance. Positive end-expiratory pressure decreased the respiratory compliance by reducing lung compliance. Conclusions: In a pig model of intra-abdominal hypertension, positive end-expiratory pressure matched to intra-abdominal pressure led to a preservation of end-expiratory lung volume, but did not improve arterial oxygen tension and caused a reduction in cardiac output. Therefore, we do not recommend routine application of positive end-expiratory pressure matched to intra-abdominal pressure to prevent intra-abdominal pressure-induced end-expiratory lung volume decline in healthy lungs.
机译：目的：腹内高压在重症患者中很常见，并与发病率和死亡率增加相关。在先前的一项实验研究中，呼气末正压高达15 cm H 2O并不能防止由腹内高压引起的呼气末肺体积下降。因此，我们检查了呼气末正压与腹内压匹配对心脏呼吸参数的影响。设计：实验猪腹腔内高压模型。地点：西澳大利亚大学大型动物设施。受试者：9头麻醉，未瘫痪和通风的猪（48±7千克）。干预：通过给腹腔内气囊充气以随机顺序产生四个水平的腹腔内压力（基线，12、18和22 mm Hg）。在每个腹腔内压力水平上随机分配三个水平的呼气末正压，并以不同程度的匹配相应的腹腔内压力：基线呼气末正压（= 5 cm H 2O），中度呼气末正压。呼气压力（=腹腔内压力的一半，单位为cm H 2O + 5 cm H 2O）和较高的呼气末正压（=腹腔内压力，单位：cm H 2O）。测量：在每次新的腹腔内压力和呼气末正压设定后5分钟，我们测量了呼气末肺体积，动脉血氧水平，呼吸力学和心输出量。主要结果：与基线静脉内高压相比，腹腔内高压降低了22 mm Hg腹腔内呼气末肺量和PaO2（分别为-49％[p <.001]和-8％[p <.05] -腹部压力），但没有改变心输出量（p = 0.5）。在每个腹腔内压力水平下，中等的呼气末正压增加了呼气末肺体积（在22 mm Hg的腹腔内压力下+ 119％[p <.001]与5 cm H 2O的呼气末正压相比），同时将心输出量降至最低（-8％，p <.05）。高呼气末正压进一步增加了呼气末肺量（与5 cm H 2O呼气末正压相比，腹腔内压力22 mm Hg时，肺呼气量增加了+ 233％[p <.001]），但导致心输出量（-26％，p <.05）。中度或高呼气末正压均不能改善PaO2（p = .7）。腹腔内高压降低了呼气末经肺压，但并未改变吸气末经肺压。腹内高压通过降低胸壁顺应性而降低了总呼吸顺应性。呼气末正压通过降低肺顺应性降低了呼吸顺应性。结论：在猪腹腔内高压模型中，呼气末正压与腹腔内正压相匹配可保持呼气末肺体积，但并未改善动脉血氧张力并导致心输出量降低。因此，我们不建议常规应用呼气末正压与腹腔内压力相匹配的方法，以防止健康肺部因腹腔内压力引起的呼气末肺体积下降。

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