{"title":"通过食管测压法测量 COVID-19 严重急性呼吸窘迫综合征重症患者从仰卧位到俯卧位的肺力学变化","authors":"Ismael Maldonado-Beltrán , Martín Armando Ríos-Ayala , Iván Armando Osuna-Padilla , Nadia Carolina Rodríguez-Moguel , Gustavo Lugo-Goytia , Carmen Margarita Hernández-Cárdenas","doi":"10.1016/j.medin.2023.07.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To describe changes in pulmonary mechanics when changing from supine position (SP) to prone position (PP) in mechanically ventilated (MV) patients with Acute Respiratory Distress Syndrome (ARDS) due to severe COVID-19.</p></div><div><h3>Design</h3><p>Retrospective cohort.</p></div><div><h3>Setting</h3><p>Intensive Care Unit of the National Institute of Respiratory Diseases (Mexico City).</p></div><div><h3>Patients</h3><p>COVID-19 patients on MV due to ARDS, with criteria for PP.</p></div><div><h3>Intervention</h3><p>Measurement of pulmonary mechanics in patients on SP to PP, using esophageal manometry.</p></div><div><h3>Main variables of interest</h3><p>Changes in lung and thoracic wall mechanics in SP and PP</p></div><div><h3>Results</h3><p>Nineteen patients were included. Changes during first prone positioning were reported. Reductions in lung stress (10.6 vs 7.7, p<!--> <!-->=<!--> <!-->0.02), lung strain (0.74 vs 0.57, p<!--> <!-->=<!--> <!-->0.02), lung elastance (p<!--> <!-->=<!--> <!-->0.01), chest wall elastance (p<!--> <!-->=<!--> <!-->0.003) and relation of respiratory system elastances (p<!--> <!-->=<!--> <!-->0.001) were observed between patients when changing from SP to PP. No differences were observed in driving pressure (p<!--> <!-->=<!--> <!-->0.19) and transpulmonary pressure during inspiration (p<!--> <!-->=<!--> <!-->0.70).</p></div><div><h3>Conclusions</h3><p>Changes in pulmonary mechanics were observed when patients were comparing values of supine position with measurements obtained 24<!--> <!-->h after prone positioning. Esophageal pressure monitoring may facilitate ventilator management despite patient positioning.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Pages 386-391"},"PeriodicalIF":2.7000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Changes in pulmonary mechanics from supine to prone position measured through esophageal manometry in critically ill patients with COVID-19 severe acute respiratory distress syndrome\",\"authors\":\"Ismael Maldonado-Beltrán , Martín Armando Ríos-Ayala , Iván Armando Osuna-Padilla , Nadia Carolina Rodríguez-Moguel , Gustavo Lugo-Goytia , Carmen Margarita Hernández-Cárdenas\",\"doi\":\"10.1016/j.medin.2023.07.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>To describe changes in pulmonary mechanics when changing from supine position (SP) to prone position (PP) in mechanically ventilated (MV) patients with Acute Respiratory Distress Syndrome (ARDS) due to severe COVID-19.</p></div><div><h3>Design</h3><p>Retrospective cohort.</p></div><div><h3>Setting</h3><p>Intensive Care Unit of the National Institute of Respiratory Diseases (Mexico City).</p></div><div><h3>Patients</h3><p>COVID-19 patients on MV due to ARDS, with criteria for PP.</p></div><div><h3>Intervention</h3><p>Measurement of pulmonary mechanics in patients on SP to PP, using esophageal manometry.</p></div><div><h3>Main variables of interest</h3><p>Changes in lung and thoracic wall mechanics in SP and PP</p></div><div><h3>Results</h3><p>Nineteen patients were included. Changes during first prone positioning were reported. Reductions in lung stress (10.6 vs 7.7, p<!--> <!-->=<!--> <!-->0.02), lung strain (0.74 vs 0.57, p<!--> <!-->=<!--> <!-->0.02), lung elastance (p<!--> <!-->=<!--> <!-->0.01), chest wall elastance (p<!--> <!-->=<!--> <!-->0.003) and relation of respiratory system elastances (p<!--> <!-->=<!--> <!-->0.001) were observed between patients when changing from SP to PP. No differences were observed in driving pressure (p<!--> <!-->=<!--> <!-->0.19) and transpulmonary pressure during inspiration (p<!--> <!-->=<!--> <!-->0.70).</p></div><div><h3>Conclusions</h3><p>Changes in pulmonary mechanics were observed when patients were comparing values of supine position with measurements obtained 24<!--> <!-->h after prone positioning. Esophageal pressure monitoring may facilitate ventilator management despite patient positioning.</p></div>\",\"PeriodicalId\":49268,\"journal\":{\"name\":\"Medicina Intensiva\",\"volume\":\"48 7\",\"pages\":\"Pages 386-391\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medicina Intensiva\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0210569123002164\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medicina Intensiva","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0210569123002164","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Changes in pulmonary mechanics from supine to prone position measured through esophageal manometry in critically ill patients with COVID-19 severe acute respiratory distress syndrome
Objective
To describe changes in pulmonary mechanics when changing from supine position (SP) to prone position (PP) in mechanically ventilated (MV) patients with Acute Respiratory Distress Syndrome (ARDS) due to severe COVID-19.
Design
Retrospective cohort.
Setting
Intensive Care Unit of the National Institute of Respiratory Diseases (Mexico City).
Patients
COVID-19 patients on MV due to ARDS, with criteria for PP.
Intervention
Measurement of pulmonary mechanics in patients on SP to PP, using esophageal manometry.
Main variables of interest
Changes in lung and thoracic wall mechanics in SP and PP
Results
Nineteen patients were included. Changes during first prone positioning were reported. Reductions in lung stress (10.6 vs 7.7, p = 0.02), lung strain (0.74 vs 0.57, p = 0.02), lung elastance (p = 0.01), chest wall elastance (p = 0.003) and relation of respiratory system elastances (p = 0.001) were observed between patients when changing from SP to PP. No differences were observed in driving pressure (p = 0.19) and transpulmonary pressure during inspiration (p = 0.70).
Conclusions
Changes in pulmonary mechanics were observed when patients were comparing values of supine position with measurements obtained 24 h after prone positioning. Esophageal pressure monitoring may facilitate ventilator management despite patient positioning.
期刊介绍：
Medicina Intensiva is the journal of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) and of Pan American and Iberian Federation of Societies of Intensive and Critical Care Medicine. Medicina Intensiva has become the reference publication in Spanish in its field. The journal mainly publishes Original Articles, Reviews, Clinical Notes, Consensus Documents, Images, and other information relevant to the specialty. All works go through a rigorous selection process. The journal accepts submissions of articles in English and in Spanish languages. The journal follows the publication requirements of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE).
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