术中以压力为基础的血管造影选择PEEP:一项概念验证研究。

IF 2 3区 医学 Q2 ANESTHESIOLOGY
Gerardo Tusman, Matías Nicolás, Alejandro Carmona, Fernando Suarez Sipmann, Ulises Tusman, Peter Kremeier, Stephan H Böhm
{"title":"术中以压力为基础的血管造影选择PEEP:一项概念验证研究。","authors":"Gerardo Tusman, Matías Nicolás, Alejandro Carmona, Fernando Suarez Sipmann, Ulises Tusman, Peter Kremeier, Stephan H Böhm","doi":"10.1007/s10877-025-01318-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to test a new method to determine the positive-end expiratory pressure (PEEP) that maintains the lungs open after a recruitment maneuver (RM).</p><p><strong>Methods: </strong>In eleven anesthetized patients, we compared the standard RM searching for the optimal PEEP based on the highest respiratory compliance (PEEP<sub>Crs</sub>), with a new method. This method performs a RM during a slow pressure-volume curve and detects the optimal PEEP using the novel barometric capnography curve (BCap); i.e. the plot of expired carbon dioxide versus airway pressure. The lungs' closing pressure was detected when the slope of phase III of the BCap changed along this slow expiration (PEEP<sub>BCap</sub>). The main objective was to compare PEEP<sub>BCap</sub> with the reference PEEP<sub>Crs</sub>. As a secondary objective, we explored the association between PEEP<sub>BCap</sub> and the polarity change in end-expiratory transpulmonary pressure (PEEP<sub>PL</sub>) during the deflation phase of a slow flow PV curve.</p><p><strong>Results: </strong>We found a PEEP<sub>BCap</sub> of 8.5(3.3) cmH<sub>2</sub>O that was no statistically different from the PEEP<sub>Crs</sub> of 10.0(4.0) cmH<sub>2</sub>O (p = 0.72). Both methods correlated well with a Rho of 0.84 (p < 0.001). The Bland-Altman plot showed a bias of 0.19 and LOA of 1.92 cmH<sub>2</sub>O (95%CI -0.39 to 0.77 cmH<sub>2</sub>O). During the PV slow deflation limb, PEEP<sub>PL</sub> was 9.3(4.3), which was statistically similar to PEEP<sub>BCap</sub> (p = 0.61). Both pressures were strongly correlated (Rho = 0.93, p < 0.001) with a bias of -0.3 cmH<sub>2</sub>O and LOA of 1.52 (95%CI -0.76 to 0.16 cmH<sub>2</sub>O).</p><p><strong>Conclusions: </strong>We concluded that BCap is feasible to detect lungs collapse using a constant flow PV curve.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intraoperative PEEP selection by pressure-based capnography: a proof of concept study.\",\"authors\":\"Gerardo Tusman, Matías Nicolás, Alejandro Carmona, Fernando Suarez Sipmann, Ulises Tusman, Peter Kremeier, Stephan H Böhm\",\"doi\":\"10.1007/s10877-025-01318-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>We aimed to test a new method to determine the positive-end expiratory pressure (PEEP) that maintains the lungs open after a recruitment maneuver (RM).</p><p><strong>Methods: </strong>In eleven anesthetized patients, we compared the standard RM searching for the optimal PEEP based on the highest respiratory compliance (PEEP<sub>Crs</sub>), with a new method. This method performs a RM during a slow pressure-volume curve and detects the optimal PEEP using the novel barometric capnography curve (BCap); i.e. the plot of expired carbon dioxide versus airway pressure. The lungs' closing pressure was detected when the slope of phase III of the BCap changed along this slow expiration (PEEP<sub>BCap</sub>). The main objective was to compare PEEP<sub>BCap</sub> with the reference PEEP<sub>Crs</sub>. As a secondary objective, we explored the association between PEEP<sub>BCap</sub> and the polarity change in end-expiratory transpulmonary pressure (PEEP<sub>PL</sub>) during the deflation phase of a slow flow PV curve.</p><p><strong>Results: </strong>We found a PEEP<sub>BCap</sub> of 8.5(3.3) cmH<sub>2</sub>O that was no statistically different from the PEEP<sub>Crs</sub> of 10.0(4.0) cmH<sub>2</sub>O (p = 0.72). Both methods correlated well with a Rho of 0.84 (p < 0.001). The Bland-Altman plot showed a bias of 0.19 and LOA of 1.92 cmH<sub>2</sub>O (95%CI -0.39 to 0.77 cmH<sub>2</sub>O). During the PV slow deflation limb, PEEP<sub>PL</sub> was 9.3(4.3), which was statistically similar to PEEP<sub>BCap</sub> (p = 0.61). Both pressures were strongly correlated (Rho = 0.93, p < 0.001) with a bias of -0.3 cmH<sub>2</sub>O and LOA of 1.52 (95%CI -0.76 to 0.16 cmH<sub>2</sub>O).</p><p><strong>Conclusions: </strong>We concluded that BCap is feasible to detect lungs collapse using a constant flow PV curve.</p>\",\"PeriodicalId\":15513,\"journal\":{\"name\":\"Journal of Clinical Monitoring and Computing\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-06-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Monitoring and Computing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10877-025-01318-7\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Monitoring and Computing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10877-025-01318-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

目的:我们的目的是测试一种新的方法来确定呼气末正压(PEEP),以维持肺在复吸操作(RM)后的开放。方法:在11例麻醉患者中,我们比较了基于最高呼吸顺应性(PEEPCrs)搜索最佳PEEP的标准RM与新方法。该方法在缓慢的压力-体积曲线中执行RM,并使用新型的气压-容积图曲线(BCap)检测最佳PEEP;即呼气二氧化碳与气道压力的关系图。当BCap III期斜率沿缓慢呼气变化(PEEPBCap)时,检测肺闭合压。主要目的是比较PEEPBCap与参考peepcr。作为次要目的,我们探讨了PEEPBCap与慢流PV曲线放气阶段呼气末转肺压(PEEPPL)极性变化之间的关系。结果:我们发现PEEPBCap为8.5(3.3)cmH2O,与PEEPCrs为10.0(4.0)cmH2O无统计学差异(p = 0.72)。两种方法的相关系数均为0.84 (p 2O) (95%CI -0.39 ~ 0.77 cmH2O)。在PV缓慢通缩期,PEEPPL为9.3(4.3),与PEEPBCap的差异有统计学意义(p = 0.61)。两种压力呈强相关(Rho = 0.93, p2o和LOA为1.52 (95%CI -0.76 ~ 0.16 cmH2O)。结论:我们认为BCap可以通过恒流量PV曲线检测肺萎陷。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intraoperative PEEP selection by pressure-based capnography: a proof of concept study.

Purpose: We aimed to test a new method to determine the positive-end expiratory pressure (PEEP) that maintains the lungs open after a recruitment maneuver (RM).

Methods: In eleven anesthetized patients, we compared the standard RM searching for the optimal PEEP based on the highest respiratory compliance (PEEPCrs), with a new method. This method performs a RM during a slow pressure-volume curve and detects the optimal PEEP using the novel barometric capnography curve (BCap); i.e. the plot of expired carbon dioxide versus airway pressure. The lungs' closing pressure was detected when the slope of phase III of the BCap changed along this slow expiration (PEEPBCap). The main objective was to compare PEEPBCap with the reference PEEPCrs. As a secondary objective, we explored the association between PEEPBCap and the polarity change in end-expiratory transpulmonary pressure (PEEPPL) during the deflation phase of a slow flow PV curve.

Results: We found a PEEPBCap of 8.5(3.3) cmH2O that was no statistically different from the PEEPCrs of 10.0(4.0) cmH2O (p = 0.72). Both methods correlated well with a Rho of 0.84 (p < 0.001). The Bland-Altman plot showed a bias of 0.19 and LOA of 1.92 cmH2O (95%CI -0.39 to 0.77 cmH2O). During the PV slow deflation limb, PEEPPL was 9.3(4.3), which was statistically similar to PEEPBCap (p = 0.61). Both pressures were strongly correlated (Rho = 0.93, p < 0.001) with a bias of -0.3 cmH2O and LOA of 1.52 (95%CI -0.76 to 0.16 cmH2O).

Conclusions: We concluded that BCap is feasible to detect lungs collapse using a constant flow PV curve.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
4.30
自引率
13.60%
发文量
144
审稿时长
6-12 weeks
期刊介绍: The Journal of Clinical Monitoring and Computing is a clinical journal publishing papers related to technology in the fields of anaesthesia, intensive care medicine, emergency medicine, and peri-operative medicine. The journal has links with numerous specialist societies, including editorial board representatives from the European Society for Computing and Technology in Anaesthesia and Intensive Care (ESCTAIC), the Society for Technology in Anesthesia (STA), the Society for Complex Acute Illness (SCAI) and the NAVAt (NAVigating towards your Anaestheisa Targets) group. The journal publishes original papers, narrative and systematic reviews, technological notes, letters to the editor, editorial or commentary papers, and policy statements or guidelines from national or international societies. The journal encourages debate on published papers and technology, including letters commenting on previous publications or technological concerns. The journal occasionally publishes special issues with technological or clinical themes, or reports and abstracts from scientificmeetings. Special issues proposals should be sent to the Editor-in-Chief. Specific details of types of papers, and the clinical and technological content of papers considered within scope can be found in instructions for authors.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信