Role of Positive End-Expiratory Pressure and Regional Transpulmonary Pressure in Asymmetrical Lung Injury

被引：18

作者：

Bastia, Luca ^{[1
,2
]}

Engelberts, Doreen ^{[1
]}

Osada, Kohei ^{[1
]}

Katira, Bhushan H. ^{[1
,3
,4
,5
]}

Damiani, L. Felipe ^{[1
,8
]}

Yoshida, Takeshi ^{[9
]}

Chen, Lu ^{[4
,10
]}

Ferguson, Niall D. ^{[4
,11
,12
]}

Amato, Marcelo B. P. ^{[13
]}

Post, Martin ^{[1
,5
]}

Kavanagh, Brian P. ^{[1
,4
,5
,6
,7
]}

Brochard, Laurent ^{[4
,10
]}

机构：

[1] Hosp Sick Children, Translat Med Program, Toronto, ON, Canada

[2] Univ Milano Bicocca, Sch Med & Surg, Monza, Italy

[3] Univ Ottawa, Childrens Hosp Eastern Ontario, Dept Pediat, Div Pediat Crit Care Med, Ottawa, ON, Canada

[4] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada

[5] Univ Toronto, Inst Med Sci, Toronto, ON, Canada

[6] Univ Toronto, Dept Crit Care Med, Hosp Sick Children, Toronto, ON, Canada

[7] Univ Toronto, Dept Anesthesia, Toronto, ON, Canada

[8] Pontificia Univ Catolica Chile, Fac Med, Dept Ciencias Salud, Carrera Kinesiol, Santiago, Chile

[9] Osaka Univ, Dept Anesthesiol & Intens Care Med, Grad Sch Med, Suita, Osaka, Japan

[10] St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, Toronto, ON, Canada

[11] Univ Hlth Network, Dept Med, Div Respirol, Toronto, ON, Canada

[12] Sinai Hlth Syst, Toronto, ON, Canada

[13] Univ Sao Paulo, Lab Pneumol LIM 09, Disciplina Pneumol, Inst Coracao Incor Hosp Clin,Fac Med, Sao Paulo, Brazil

来源：

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE | 2021年 / 203卷 / 08期

基金：

加拿大健康研究院;

关键词：

acute lung injury; esophageal pressure; respiratory mechanics; mechanical ventilation; monitoring; TRACHEAL GAS INSUFFLATION; ESOPHAGEAL PRESSURE; AIRWAY-CLOSURE; VENTILATION; ATELECTASIS; PNEUMONIA; FAILURE; MODEL;

D O I：

10.1164/rccm.202005-1556OC

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Rationale: Asymmetrical lung injury is a frequent clinical presentation. Regional distribution of V-T and positive end-expiratory pressure (PEEP) could result in hyperinflation of the less-injured lung. The validity of esophageal pressure (Pes) is unknown. Objectives: To compare, in asymmetrical lung injury, Pes with directly measured pleural pressures (Ppl) of both sides and investigate how PEEP impacts ventilation distribution and the regional driving transpulmonary pressure (inspiratory - expiratory). Methods: Fourteen mechanically ventilated pigs with lung injury were studied. One lung was blocked while the contralateral one underwent surfactant lavage and injurious ventilation. Airway pressure and Pes were measured, as was Ppl in the dorsal and ventral pleural space adjacent to each lung. Distribution of ventilation was assessed by electrical impedance tomography. PEEP was studied through decremental steps. Measurements and Results: Ventral and dorsal Ppl were similar between the injured and the noninjured lung across all PEEP levels. Dorsal Ppl and Pes were similar. The driving transpulmonary pressure was similar in the two lungs. VT distribution between lungs was different at zero end-expiratory pressure (similar to 70% of VT going in noninjured lung) owing to different respiratory system compliance (8.3 ml/cm H2O noninjured lung vs. 3.7 ml/cm H2O injured lung). PEEP at 10 cm H2O with transpulmonary pressure around zero homogenized VT distribution opening the lungs. PEEP>16 cm H2O equalized distribution of VT but with overdistension for both lungs. Conclusions: Despite asymmetrical lung injury, Ppl between injured and noninjured lungs is equalized and esophageal pressure is a reliable estimate of dorsal Ppl. Driving transpulmonary pressure is similar for both lungs. VT distribution results from regional respiratory system compliance. Moderate PEEP homogenizes VT distribution between lungs without generating hyperinflation.

引用

页码：969 / 976

页数：8

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