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P/V Tool® Pro。 评估肺复张潜力并执行肺复张术

黄色气囊在不同阶段。

是否适合肺复张? 诊断工具

保护通气工具 (P/V Tool Pro) 采用呼吸力学方法记录准静态压力-容量曲线,该曲线描述肺部和胸壁在吸气和呼气过程中的力学行为。

此方法可用于评估肺复张性和确定需要应用的肺复张策略 (Demory D, Arnal JM, Wysocki M, et al.Recruitability of the lung estimated by the pressure volume curve hysteresis in ARDS patients.Intensive Care Med.2008;34(11):2019-2025. doi:10.1007/s00134-008-1167-81​)。

统计图:P/V Tool Pro 图示

正确的策略是什么? 肺复张工具

P/V Tool Pro 也可用于进行持续充气肺复张操作和测量肺容量的增加(肺复张操作白皮书2​​)。您可以在肺复张操作后设置压力上升时间、最大压力、持续时间和 PEEP 水平,以适合个体病人。

这对 ARDS 病人特别有效,因为选择适当的肺复张策略及 PEEP 正确设为抗塌陷力对此病人组至关重要 (Gattinoni L, Caironi P, Cressoni M, et al.Lung recruitment in patients with the acute respiratory distress syndrome.N Engl J Med.2006;354(17):1775-1786. doi:10.1056/NEJMoa0520523​)。

管路注射器

能否改善您的通气策略? 肺保护工具

与食道压测量结合,P/V Tool Pro 可让您更清楚地了解肺和胸壁力学。

这有利于您通过滴定 PEEP 水平 (Caironi P, Cressoni M, Chiumello D, et al.Lung opening and closing during ventilation of acute respiratory distress syndrome.Am J Respir Crit Care Med.2010;181(6):578-586. doi:10.1164/rccm.200905-0787OC4​) 和优化肺复张操作参数,然后优化驱动压力和潮气量参数,应用肺保护性通气策略。

P/V Tool Pro 用户界面 P/V Tool Pro 用户界面

工作原理是什么? P/V Tool Pro 工作原理

您可以执行 P/V Tool Pro 操作,而无需断开呼吸管路或更改通气模式或呼吸机设置。可以随时恢复正常通气。P/V Tool Pro 记录低流量状况下 (2–5 cmH2O/s) 肺部的压力-容量相关性。

吸气时,压力逐渐递增至操作员设定的压力目标值。当压力达到目标值时,转换呼气,压力回降到设置的数值。

Ken Hargett Camille Neville

客户评语

对于几乎所有镇静下来以待插管的呼吸机病人,我们使用 P/V Tool 来确定初始 PEEP 设置。P/V Tool 的肺复张这部分功能,我们也用得很多,特别是患有反复肺不张的病人。

Ken Hargett

呼吸治疗主任(直至 2019 年)
美国德克萨斯州休斯敦卫理公会医院

客户评语

我们的呼吸治疗师给病人接上呼吸机后立即使用 P/V Tool,以获得最佳 PEEP。治疗师发现它很有用,尤其是对重病病人。

Camille Neville

呼吸科临床教师
美国佛罗里达州奥兰多佛罗里达医院

统计图:Amato MB.Nengl J Med.1998 Feb 5;338(6):347-54

您有证据吗? 了解证据

肺保护是病人进行机械通气时的一个主要目标。

在氧合状态、肺复张容积或过度充气改变方面,肺特征和组织形态是 PEEP 设置或肺复张操作反应的有力预测因素 (Constantin JM, Futier E, Cherprenet AL, et al.A recruitment maneuver increases oxygenation after intubation of hypoxemic intensive care unit patients: a randomized controlled study.Crit Care.2010;14(2):R76. doi:10.1186/cc89895​)。

如果正确评估肺组织形态,个性化策略可以降低中度到严重 ARDS 病人的死亡率 (Constantin JM, Jabaudon M, Lefrant JY, et al.Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial.Lancet Respir Med.2019;7(10):870-880. doi:10.1016/S2213-2600(19)30138-96)。肺保护不仅可以降低 ARDS 病人的死亡率 (Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al.Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.N Engl J Med.2000;342(18):1301-1308. doi:10.1056/NEJM2000050434218017),还可减少正常肺病人继发性 ARDS (Determann RM, Royakkers A, Wolthuis EK, et al.Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial.Crit Care.2010;14(1):R1. doi:10.1186/cc82308) 及术后病人并发症的风险 (Costa Leme A, Hajjar LA, Volpe MS, et al.Effect of Intensive vs Moderate Alveolar Recruitment Strategies Added to Lung-Protective Ventilation on Postoperative Pulmonary Complications: A Randomized Clinical Trial.JAMA.2017;317(14):1422-1432. doi:10.1001/jama.2017.22979​, Hu MC, Yang YL, Chen TT, Chen JT, Tiong TY, Tam KW.Recruitment maneuvers in patients undergoing thoracic surgery: a meta-analysis.Gen Thorac Cardiovasc Surg.2021;69(12):1553-1559. doi:10.1007/s11748-021-01673-7 10​)。

图:手持证书的学生

不可不知! P/V Tool 培训资源

可用性

P/V Tool Pro 可作为 HAMILTON-C3/C6 和 HAMILTON-G5 呼吸机的选配功能以及 HAMILTON-S1 呼吸机的标准功能提供。

参考文献

  1. 1. Demory D, Arnal JM, Wysocki M, et al. Recruitability of the lung estimated by the pressure volume curve hysteresis in ARDS patients. Intensive Care Med. 2008;34(11):2019-2025. doi:10.1007/s00134-008-1167-8
  2. 2. ELO20160409S.01
  3. 3. Gattinoni L, Caironi P, Cressoni M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 2006;354(17):1775-1786. doi:10.1056/NEJMoa052052
  4. 4. Caironi P, Cressoni M, Chiumello D, et al. Lung opening and closing during ventilation of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2010;181(6):578-586. doi:10.1164/rccm.200905-0787OC
  5. 5. Constantin JM, Futier E, Cherprenet AL, et al. A recruitment maneuver increases oxygenation after intubation of hypoxemic intensive care unit patients: a randomized controlled study. Crit Care. 2010;14(2):R76. doi:10.1186/cc8989

 

  1. 6. Constantin JM, Jabaudon M, Lefrant JY, et al. Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial. Lancet Respir Med. 2019;7(10):870-880. doi:10.1016/S2213-2600(19)30138-9
  2. 7. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301-1308. doi:10.1056/NEJM200005043421801
  3. 8. Determann RM, Royakkers A, Wolthuis EK, et al. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Crit Care. 2010;14(1):R1. doi:10.1186/cc8230
  4. 9. Costa Leme A, Hajjar LA, Volpe MS, et al. Effect of Intensive vs Moderate Alveolar Recruitment Strategies Added to Lung-Protective Ventilation on Postoperative Pulmonary Complications: A Randomized Clinical Trial. JAMA. 2017;317(14):1422-1432. doi:10.1001/jama.2017.2297
  5. 10. Hu MC, Yang YL, Chen TT, Chen JT, Tiong TY, Tam KW. Recruitment maneuvers in patients undergoing thoracic surgery: a meta-analysis. Gen Thorac Cardiovasc Surg. 2021;69(12):1553-1559. doi:10.1007/s11748-021-01673-7

脚注

 

Recruitability of the lung estimated by the pressure volume curve hysteresis in ARDS patients.

Authors: Didier Demory, Jean-Michel Arnal, Marc Wysocki, Stéphane Donati, Isabelle Granier, Gaëlle Corno, Jacques Durand-Gasselin

Lung recruitment in patients with the acute respiratory distress syndrome.

Authors: Luciano Gattinoni, Pietro Caironi, Massimo Cressoni, Davide Chiumello, V Marco Ranieri, Michael Quintel, Sebastiano Russo, Nicolò Patroniti, Rodrigo Cornejo, Guillermo Bugedo

Lung opening and closing during ventilation of acute respiratory distress syndrome.

Authors: Pietro Caironi, Massimo Cressoni, Davide Chiumello, Marco Ranieri, Michael Quintel, Sebastiano G Russo, Rodrigo Cornejo, Guillermo Bugedo, Eleonora Carlesso, Riccarda Russo, Luisa Caspani, Luciano Gattinoni

A recruitment maneuver increases oxygenation after intubation of hypoxemic intensive care unit patients: a randomized controlled study.

Authors: Jean-Michel Constantin, Emmanuel Futier, Anne-Laure Cherprenet, Gérald Chanques, Renaud Guerin, Sophie Cayot-Constantin, Mathieu Jabaudon, Sebastien Perbet, Christian Chartier, Boris Jung, Dominique Guelon, Samir Jaber, Jean-Etienne Bazin

Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial.

Authors: Jean-Michel Constantin, Matthieu Jabaudon, Jean-Yves Lefrant, Samir Jaber, Jean-Pierre Quenot, Olivier Langeron, Martine Ferrandière, Fabien Grelon, Philippe Seguin, Carole Ichai, Benoit Veber, Bertrand Souweine, Thomas Uberti, Sigismond Lasocki, François Legay, Marc Leone, Nathanael Eisenmann, Claire Dahyot-Fizelier, Hervé Dupont, Karim Asehnoune, Achille Sossou, Gérald Chanques, Laurent Muller, Jean-Etienne Bazin, Antoine Monsel, Lucile Borao, Jean-Marc Garcier, Jean-Jacques Rouby, Bruno Pereira, Emmanuel Futier

Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.

Authors: Roy G Brower, Michael A Matthay, Alan Morris, David Schoenfeld, B Taylor Thompson, Arthur Wheeler

Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial.

Authors: Rogier M Determann, Annick Royakkers, Esther K Wolthuis, Alexander P Vlaar, Goda Choi, Frederique Paulus, Jorrit-Jan Hofstra, Mart J de Graaff, Johanna C Korevaar, Marcus J Schultz

Effect of Intensive vs Moderate Alveolar Recruitment Strategies Added to Lung-Protective Ventilation on Postoperative Pulmonary Complications: A Randomized Clinical Trial.

Authors: Alcino Costa Leme, Ludhmila Abrahao Hajjar, Marcia S Volpe, Julia Tizue Fukushima, Roberta Ribeiro De Santis Santiago, Eduardo A Osawa, Juliano Pinheiro de Almeida, Aline Muller Gerent, Rafael Alves Franco, Maria Ignez Zanetti Feltrim, Emília Nozawa, Vera Regina de Moraes Coimbra, Rafael de Moraes Ianotti, Clarice Shiguemi Hashizume, Roberto Kalil Filho, Jose Otavio Costa Auler, Fabio Biscegli Jatene, Filomena Regina Barbosa Gomes Galas, Marcelo Britto Passos Amato

Recruitment maneuvers in patients undergoing thoracic surgery: a meta-analysis.

Authors: Ming-Chi Hu, You-Lan Yang, Tzu-Tao Chen, Jui-Tai Chen, Tung-Yu Tiong, Ka-Wai Tam