科研之友
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摘要
BACKGROUND: Because of limitations of the esophageal balloon technique, the value of using esophageal pressure (P-es) guided end-expiratory transpulmonary pressure (PL-exp) to maintain lung recruitment in adult respiratory distress syndrome is controversial. This study aimed to investigate whether tailoring PL-exp to greater than 0 was enough to maintain lung recruitment. @@@ METHODS: Ten pigs with severe lavage-induced lung injury were mechanically ventilated in a decremental positive end-expiratory pressure (PEEP) trial that was reduced from 20 to 6 cm H2O after full-lung recruitment. Respiratory mechanics, blood gases, hemodynamic data, and whole-lung computed tomography scans were recorded at each PEEP level. Open-lung PEEP (OL-PEEP) was determined by computed tomography, while P-es-guided PEEP (P-es-PEEP) was to maintain PL-exp greater than 0. @@@ RESULTS: OL-PEEP was higher than P-es-PEEP, which induced a higher PL-exp at OL-PEEP than at P-es-PEEP (4.6 [1.6] cm H2O vs. 1.2 [0.6] cm H2O, p < 0.001). Compared with OL-PEEP, the nonaerated lung region was significantly increased at P-es-PEEP. Superimposed pressure (SP) of the lung tissue between the esophageal plane and the dorsal level was higher at P-es-PEEP than at OL-PEEP, whereas PL-exp at the dorsal level was lower at P-es-PEEP than at OL-PEEP (-1.5 [0.7] cm H2O vs. 2.5 [1.5] cm H2O, p < 0.001). The SP correlated with PL-exp at the dorsal level and the nonaerated lung region. @@@ CONCLUSION: In this surfactant-depleted model, maintaining PL-exp just greater than 0 using P-es was unable to maintain lung recruitment; this was partly caused by a lack of compensation for the increased SP between the esophageal plane and the dorsal level.
