Shreyas S Anegundi, Madhuri S Kurdi, Jagadish G Sutagatti, Kaushik A Theerth
{"title":"肺超声在评估机械通气患者呼气末正压诱导肺复吸中的作用。","authors":"Shreyas S Anegundi, Madhuri S Kurdi, Jagadish G Sutagatti, Kaushik A Theerth","doi":"10.5492/wjccm.v14.i3.102609","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Lung ultrasonography is being increasingly used in mechanically ventilated patients to evaluate the lung aeration during incremental positive end expiratory pressure (PEEP) adjustments and to evaluate the weaning process from mechanical ventilation. The effects of PEEP may vary across different lung pathologies and may not consistently correlate with changes in lung aeration as assessed by lung ultrasound scores (LUSs).</p><p><strong>Aim: </strong>To assess the role of lung ultrasonography in evaluating lung aeration during the application of PEEP in mechanically ventilated patients with various lung pathologies.</p><p><strong>Methods: </strong>An observational study was conducted over 18 months in a tertiary care hospital. Patients of both genders, aged between 18-75 years, who had been admitted to the intensive care unit, and required mechanical ventilation, were studied. A standard ventilatory strategy was used and incremental levels of PEEP [5, 10, and 15 cm water (H<sub>2</sub>O)] were applied. Baseline characteristics, including oxygen saturation (SpO<sub>2</sub>), LUS, mean arterial pressure (MAP), heart rate (HR), and their changes with incremental PEEP levels, were recorded and analyzed.</p><p><strong>Results: </strong>In this study, 45.9% of patients required a PEEP of 5 cm H<sub>2</sub>O to achieve the endpoint of lung aeration (LUS of 0). In addition, 86.5% and 13.5% of patients reached the endpoint of lung aeration at PEEP levels of 10 and 15 cm H<sub>2</sub>O, respectively. The proportion of patients with higher lung scores decreased significantly with increasing PEEP levels (<i>P</i> < 0.001 for 5 and 10 cm H<sub>2</sub>O and <i>P</i> = 0.032 for 15 cm H<sub>2</sub>O). SpO<sub>2</sub> increased significantly with higher PEEP levels (<i>P</i> < 0.001), confirming the effectiveness of PEEP in improving oxygenation. The results also revealed a significant increase in HR and a decrease in MAP following the application of higher PEEP levels.</p><p><strong>Conclusion: </strong>Increasing PEEP levels in mechanically ventilated patients improves lung aeration, which can be effectively assessed using bedside lung ultrasonography.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"14 3","pages":"102609"},"PeriodicalIF":0.0000,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304999/pdf/","citationCount":"0","resultStr":"{\"title\":\"Role of lung ultrasound in assessing positive end expiratory pressure induced lung recruitment in patients on mechanical ventilation.\",\"authors\":\"Shreyas S Anegundi, Madhuri S Kurdi, Jagadish G Sutagatti, Kaushik A Theerth\",\"doi\":\"10.5492/wjccm.v14.i3.102609\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Lung ultrasonography is being increasingly used in mechanically ventilated patients to evaluate the lung aeration during incremental positive end expiratory pressure (PEEP) adjustments and to evaluate the weaning process from mechanical ventilation. The effects of PEEP may vary across different lung pathologies and may not consistently correlate with changes in lung aeration as assessed by lung ultrasound scores (LUSs).</p><p><strong>Aim: </strong>To assess the role of lung ultrasonography in evaluating lung aeration during the application of PEEP in mechanically ventilated patients with various lung pathologies.</p><p><strong>Methods: </strong>An observational study was conducted over 18 months in a tertiary care hospital. Patients of both genders, aged between 18-75 years, who had been admitted to the intensive care unit, and required mechanical ventilation, were studied. A standard ventilatory strategy was used and incremental levels of PEEP [5, 10, and 15 cm water (H<sub>2</sub>O)] were applied. Baseline characteristics, including oxygen saturation (SpO<sub>2</sub>), LUS, mean arterial pressure (MAP), heart rate (HR), and their changes with incremental PEEP levels, were recorded and analyzed.</p><p><strong>Results: </strong>In this study, 45.9% of patients required a PEEP of 5 cm H<sub>2</sub>O to achieve the endpoint of lung aeration (LUS of 0). In addition, 86.5% and 13.5% of patients reached the endpoint of lung aeration at PEEP levels of 10 and 15 cm H<sub>2</sub>O, respectively. The proportion of patients with higher lung scores decreased significantly with increasing PEEP levels (<i>P</i> < 0.001 for 5 and 10 cm H<sub>2</sub>O and <i>P</i> = 0.032 for 15 cm H<sub>2</sub>O). SpO<sub>2</sub> increased significantly with higher PEEP levels (<i>P</i> < 0.001), confirming the effectiveness of PEEP in improving oxygenation. The results also revealed a significant increase in HR and a decrease in MAP following the application of higher PEEP levels.</p><p><strong>Conclusion: </strong>Increasing PEEP levels in mechanically ventilated patients improves lung aeration, which can be effectively assessed using bedside lung ultrasonography.</p>\",\"PeriodicalId\":66959,\"journal\":{\"name\":\"世界危重病急救学杂志(英文版)\",\"volume\":\"14 3\",\"pages\":\"102609\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-09-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304999/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"世界危重病急救学杂志(英文版)\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5492/wjccm.v14.i3.102609\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"世界危重病急救学杂志(英文版)","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5492/wjccm.v14.i3.102609","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景：肺超声越来越多地用于机械通气患者在增量呼气末正压（PEEP）调整期间的肺通气和评估机械通气的脱机过程。PEEP的影响可能因不同的肺部病理而异，并且可能与肺超声评分（LUSs）评估的肺通气量变化不一致。目的：探讨肺动脉正压通气（PEEP）在不同肺病理机械通气患者肺通气中的应用价值。方法：在一家三级医院进行了为期18个月的观察性研究。研究对象为年龄在18-75岁之间、曾入住重症监护室并需要机械通气的男女患者。采用标准的通气策略，并应用增量PEEP[5、10和15 cm水（H2O）]。记录并分析基线特征，包括血氧饱和度（SpO2）、LUS、平均动脉压（MAP）、心率（HR）及其随PEEP升高的变化。结果：在本研究中，45.9%的患者需要5 cm H2O的PEEP才能达到肺通气终点（LUS为0）。此外，86.5%和13.5%的患者分别在PEEP水平为10和15 cm H2O时达到肺通气终点。随着PEEP水平的升高，肺评分较高的患者比例显著降低（5、10 cm H2O P < 0.001, 15 cm H2O P = 0.032）。SpO2随PEEP升高而显著升高（P < 0.001），证实了PEEP改善氧合的有效性。结果还显示，在应用较高的PEEP水平后，HR显著增加，MAP显著降低。结论：机械通气患者PEEP升高可改善肺通气，床边肺超声检查可有效评价其通气效果。
Role of lung ultrasound in assessing positive end expiratory pressure induced lung recruitment in patients on mechanical ventilation.
Background: Lung ultrasonography is being increasingly used in mechanically ventilated patients to evaluate the lung aeration during incremental positive end expiratory pressure (PEEP) adjustments and to evaluate the weaning process from mechanical ventilation. The effects of PEEP may vary across different lung pathologies and may not consistently correlate with changes in lung aeration as assessed by lung ultrasound scores (LUSs).
Aim: To assess the role of lung ultrasonography in evaluating lung aeration during the application of PEEP in mechanically ventilated patients with various lung pathologies.
Methods: An observational study was conducted over 18 months in a tertiary care hospital. Patients of both genders, aged between 18-75 years, who had been admitted to the intensive care unit, and required mechanical ventilation, were studied. A standard ventilatory strategy was used and incremental levels of PEEP [5, 10, and 15 cm water (H2O)] were applied. Baseline characteristics, including oxygen saturation (SpO2), LUS, mean arterial pressure (MAP), heart rate (HR), and their changes with incremental PEEP levels, were recorded and analyzed.
Results: In this study, 45.9% of patients required a PEEP of 5 cm H2O to achieve the endpoint of lung aeration (LUS of 0). In addition, 86.5% and 13.5% of patients reached the endpoint of lung aeration at PEEP levels of 10 and 15 cm H2O, respectively. The proportion of patients with higher lung scores decreased significantly with increasing PEEP levels (P < 0.001 for 5 and 10 cm H2O and P = 0.032 for 15 cm H2O). SpO2 increased significantly with higher PEEP levels (P < 0.001), confirming the effectiveness of PEEP in improving oxygenation. The results also revealed a significant increase in HR and a decrease in MAP following the application of higher PEEP levels.
Conclusion: Increasing PEEP levels in mechanically ventilated patients improves lung aeration, which can be effectively assessed using bedside lung ultrasonography.
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