目的探讨有创机械通气患者在通过自主呼吸试验后拔管失败的危险因素。方法对2006年5月～2007年10月入住中山医院急诊ICU并接受有创机械通气48 h以上的患者进行前瞻性调查,采用7 cm H2O的压力支持模式持续30 min进行自主呼吸试验,记录自...目的探讨有创机械通气患者在通过自主呼吸试验后拔管失败的危险因素。方法对2006年5月～2007年10月入住中山医院急诊ICU并接受有创机械通气48 h以上的患者进行前瞻性调查,采用7 cm H2O的压力支持模式持续30 min进行自主呼吸试验,记录自主呼吸试验前后的临床资料,按照拔管结局将患者分为拔管成功组和拔管失败组。结果58例患者通过自主呼吸试验后拔管,其中47例(81%)拔管成功,11例(19%)拔管失败进行再插管。单因素分析显示:老年人[拔管失败组年龄(78.1±7.9)岁,拔管成功组年龄(67.4±15.1)岁,P<0.05]、较高的浅快呼吸指数[拔管失败组(83±12)次.min-1.L-1,拔管成功组(68±19)次.min-1.L-1,P<0.05]以及较多的气道分泌物(拔管失败组54.5%,拔管成功组21.3%,P<0.05)与拔管失败有关。结论有创机械通气患者在通过自主呼吸试验后,年龄、浅快呼吸指数及气道分泌物量是预测拔管失败的有效指标。展开更多
Background:Conventional pressure support ventilation(PSP)is triggered and cycled off by pneumatic signals such as flow.Patient-ventilator asynchrony is common during pressure support ventilation,thereby contributing t...Background:Conventional pressure support ventilation(PSP)is triggered and cycled off by pneumatic signals such as flow.Patient-ventilator asynchrony is common during pressure support ventilation,thereby contributing to an increased inspiratory effort.Using diaphragm electrical activity,neurally controlled pressure support(PSN)could hypothetically eliminate the asynchrony and reduce inspiratory effort.The purpose of this study was to compare the differences between PSN and PSP in terms of patient-ventilator synchrony,inspiratory effort,and breathing pattern.Methods:Eight post-operative patients without respiratory system comorbidity,eight patients with acute respiratory distress syndrome(ARDS)and obvious restrictive acute respiratory failure(ARF),and eight patients with chronic obstructive pulmonary disease(COPD)and mixed restrictive and obstructive ARF were enrolled.Patient-ventilator interactions were analyzed with macro asynchronies(ineffective,double,and auto triggering),micro asynchronies(inspiratory trigger delay,premature,and late cycling),and the total asynchrony index(AI).Inspiratory efforts for triggering and total inspiration were analyzed.Results:Total AI of PSN was consistently lower than that of PSP in COPD(3%vs.93%,P=0.012 for 100%support level;8%vs.104%,P=0.012 for 150%support level),ARDS(8%vs.29%,P=0.012 for 100%support level;16%vs.41%,P=0.017 for 150%support level),and post-operative patients(21%vs.35%,P=0.012 for 100%support level;15%vs.50%,P=0.017 for 150%support level).Improved support levels from 100%to 150%statistically increased total AI during PSP but not during PSN in patients with COPD or ARDS.Patients’inspiratory efforts for triggering and total inspiration were significantly lower during PSN than during PSP in patients with COPD or ARDS under both support levels(P<0.05).There was no difference in breathing patterns between PSN and PSP.Conclusions:PSN improves patient-ventilator synchrony and generates a respiratory pattern similar to PSP independently of any level of support in patie展开更多
文摘目的探讨有创机械通气患者在通过自主呼吸试验后拔管失败的危险因素。方法对2006年5月～2007年10月入住中山医院急诊ICU并接受有创机械通气48 h以上的患者进行前瞻性调查,采用7 cm H2O的压力支持模式持续30 min进行自主呼吸试验,记录自主呼吸试验前后的临床资料,按照拔管结局将患者分为拔管成功组和拔管失败组。结果58例患者通过自主呼吸试验后拔管,其中47例(81%)拔管成功,11例(19%)拔管失败进行再插管。单因素分析显示:老年人[拔管失败组年龄(78.1±7.9)岁,拔管成功组年龄(67.4±15.1)岁,P<0.05]、较高的浅快呼吸指数[拔管失败组(83±12)次.min-1.L-1,拔管成功组(68±19)次.min-1.L-1,P<0.05]以及较多的气道分泌物(拔管失败组54.5%,拔管成功组21.3%,P<0.05)与拔管失败有关。结论有创机械通气患者在通过自主呼吸试验后,年龄、浅快呼吸指数及气道分泌物量是预测拔管失败的有效指标。
基金National Science and Technology Major Project(No.2020ZX09201015)Clinical Science and Technology Specific Projects of Jiangsu Province(Nos.BE2018743,BE2019749)+3 种基金National Natural Science Foundation of China(Nos.81870066,81670074,81930058)Natural Science Foundation of Jiangsu Province(No.BK20171271)Jiangsu Provincial Medical Youth Talent(No.QNRC 2016807)Third Level Talents of the"333 High Level Talents Training Project"in the fifth phase in Jiangsu(No.LGY2016051)。
文摘Background:Conventional pressure support ventilation(PSP)is triggered and cycled off by pneumatic signals such as flow.Patient-ventilator asynchrony is common during pressure support ventilation,thereby contributing to an increased inspiratory effort.Using diaphragm electrical activity,neurally controlled pressure support(PSN)could hypothetically eliminate the asynchrony and reduce inspiratory effort.The purpose of this study was to compare the differences between PSN and PSP in terms of patient-ventilator synchrony,inspiratory effort,and breathing pattern.Methods:Eight post-operative patients without respiratory system comorbidity,eight patients with acute respiratory distress syndrome(ARDS)and obvious restrictive acute respiratory failure(ARF),and eight patients with chronic obstructive pulmonary disease(COPD)and mixed restrictive and obstructive ARF were enrolled.Patient-ventilator interactions were analyzed with macro asynchronies(ineffective,double,and auto triggering),micro asynchronies(inspiratory trigger delay,premature,and late cycling),and the total asynchrony index(AI).Inspiratory efforts for triggering and total inspiration were analyzed.Results:Total AI of PSN was consistently lower than that of PSP in COPD(3%vs.93%,P=0.012 for 100%support level;8%vs.104%,P=0.012 for 150%support level),ARDS(8%vs.29%,P=0.012 for 100%support level;16%vs.41%,P=0.017 for 150%support level),and post-operative patients(21%vs.35%,P=0.012 for 100%support level;15%vs.50%,P=0.017 for 150%support level).Improved support levels from 100%to 150%statistically increased total AI during PSP but not during PSN in patients with COPD or ARDS.Patients’inspiratory efforts for triggering and total inspiration were significantly lower during PSN than during PSP in patients with COPD or ARDS under both support levels(P<0.05).There was no difference in breathing patterns between PSN and PSP.Conclusions:PSN improves patient-ventilator synchrony and generates a respiratory pattern similar to PSP independently of any level of support in patie
