对于ARDS患者来说,选择最合适PEEP水平,有利于开放萎陷的肺泡和预防相对正常/已开放的陷闭肺区过度膨胀。 图1 PEEP与肺泡通气 一、PEEP的生理学效应 图2 陷闭肺区的肺泡-吸气期扩张,呼气期完全回缩
但在过高的PEEP水平也可能导致不良影响,如在相对正常肺区。
二、PEEP的滴定 1. PEEP-FiO2表格 2. 氧合情况 3. 静态顺应性 图4 顺应性与PEEP 图4-a曲线中,肺容积增长最快的点即被认为肺顺应性最好的点。 4. 压力-容积曲线 5. 牵张指数
6. 食道压 7. 肺部超声 图8 ARDS肺部超声图像 9. 电阻抗成像 参考文献 [1] Hess DR. Recruitment Maneuvers and PEEP Titration[J]. Respir Care, 2015, 60(11):1688-1704. [2] Sahetya SK. Searching for the optimal positive end-expiratory pressure for lung protective ventilation[J]. Curr Opin Crit Care, 2020, 26(1):53-58. [3] Kacmarek RM, Villar J. Management of refractory hypoxemia in ARDS[J]. Minerva Anestesiol, 2013, 79(10):1173-1179. [4] Brower RG, Lanken PN, MacIntyre N, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome[J]. N Engl J Med, 2004, 351(4):327-336. [5] Pettenuzzo T, Boscolo A, De Cassai A, et al. Higher versus lower positive end-expiratory pressure in patients without acute respiratory distress syndrome: a meta-analysis of randomized controlled trials[J]. Crit Care, 2021, 25(1):247. [6] Bello G, Blanco P. Lung Ultrasonography for Assessing Lung Aeration in Acute Respiratory Distress Syndrome: A Narrative Review[J]. J Ultrasound Med, 2019, 38(1):27-37. [7] Pintado MC, de Pablo R, Trascasa M, et al. Individualized PEEP setting in subjects with ARDS: a randomized controlled pilot study[J]. Respir Care, 2013, 58(9):1416-1423. [8] Akoumianaki E, Maggiore SM, Valenza F, et al. The application of esophageal pressure measurement in patients with respiratory failure[J]. Am J Respir Crit Care Med, 2014, 189(5):520-531. [9] Chiumello D, Cressoni M, Carlesso E, et al. Bedside selection of positive end-expiratory pressure in mild, moderate, and severe acute respiratory distress syndrome[J]. Crit Care Med, 2014, 42(2):252-264. 声明: |
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