吸气肌压力指数评价低吸气努力的可行性和有效性

doi:10.3969/j.issn.1006-7795.2024.02.004

首都医科大学学报 ›› 2024, Vol. 45 ›› Issue (2): 194-200.doi: 10.3969/j.issn.1006-7795.2024.02.004

• 重症医学诊疗技术与进展 • 上一篇下一篇

吸气肌压力指数评价低吸气努力的可行性和有效性

宋德婧^1,3#, 高然^1#, 杨燕琳¹, 张琳琳¹, 周建新^2*

1.首都医科大学附属北京天坛医院重症医学科，北京 100070； 2.首都医科大学附属北京世纪坛医院重症医学科，北京 100038；3.中日友好医院重症医学科，北京 100029

收稿日期:2023-12-19 出版日期:2024-04-21 发布日期:2024-04-25
通讯作者: 周建新 E-mail:zhoujx.cn@icloud.com
基金资助:
首都卫生发展科研专项项目（2024-1-2081），2022年度北京市重大疫情防治重点专科项目(2022-ZX-007)。

The feasibility and validity of inspiratory muscle pressure index to assess inspiratory effort

Song Dejing^1,3#, Gao Ran^1#, Yang Yanlin¹, Zhang Linlin¹, Zhou Jianxin^2*

1.Department of Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China；2.Department of Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China；3.Department of Intensive Care Unit, China-Japan Friendship Hospital, Beijing 100029, China

Received:2023-12-19 Online:2024-04-21 Published:2024-04-25
Supported by:
This study was supported by Capital's Funds for Health Improvement and Research Medical Development Fund (2024-1-2081), Major Epidemic Prevention and Control of Key Clinical Specialty Projects of Beijing (2022) (2022-ZX-007) .

摘要/Abstract

摘要： 目的探索在压力支持通气（pressure support ventilation, PSV）模式下，通过压力监测设备获得肌肉压力指数（reference measurement of inspiratory muscle pressure index on experimental condition，PMIref）和通过呼吸机屏幕获得PMI（simple measurement of PMI from the ventilator, PMIvent）的一致性，PMIvent与吸气努力的相关性，以及PMI评价低吸气努力的预测价值。方法本研究纳入2022年6月至2023年6月间22例使用PSV模式的成年急性呼吸衰竭患者，将压力支持（support pressure, PS）水平从20 cmH₂O到2 cmH₂O（1 cmH2O=0.098 kPa）进行滴定，每个PS水平进行吸气末保持和呼气末保持，记录流量、气道压和食道压信号，计算PMIref、PMIvent和食道-压力时间乘积（esophageal pressure-time product, PTPes）。采用Bland-Altman检验分析PMIvent与PMIref的一致性，采用决定系数（R²）评估PMI与吸气努力之间的相关性，采用受试者工作特征（receiver operating characteristic, ROC）曲线的方法评估PMI检测低努力的诊断效能，根据约登指数确定最佳临界值。结果 PMIvent和PMIref之间的残差（95%一致性区间）为0.18（-0.44~0.80）。PMIref和PTPes/min显著相关（患者间R²=0.61，患者内R²=0.80），PMIvent与 PTPes/min显著相关（患者间R²=0.62，患者内R²=0.81）。对于临界值PTPes<50 cmH₂O·s·min^-1时，PMIvent的ROC曲线下面积（area under the curve, AUC）为0.93(0.89，0.96)，最佳临界值为-0.77 cmH₂O。结论通过呼吸机获得的PMIvent可以有效替代实验条件下测量的PMIref。PMIvent和PMIref都与吸气努力显著相关，具有预测低吸气努力的潜在价值。

关键词: 机械通气, 吸气努力, 肌肉压力指数, 食道压力-时间乘积

Abstract: Objective To explore the correlation of simple measurement of inspiratory muscle pressure index from the ventilator (PMIvent) and reference measurement of inspiratory muscle pressure index on experimental condition (PMIref), the relationship between PMIvent and inspiratory effort, and further to determine the clinical feasibility and validity of PMI for assessing inspiratory effort during pressure support ventilation (PSV). Methods Adult acute respiratory failure patients undergoing mechanical ventilation were screened daily and enrolled 24 h after switching to PSV mode. Baseline ventilators were set according to the principle of keeping tidal volume/ predicted body weight(VT/PBW) at 6-8 mL/kg and respiratory rate (RR) at 20-30 breaths/min and the decision of the responsible ICU physician. A downward support pressure ( PS )titration was conducted from 20 cmH₂O to 2 cmH₂O. Three end-inspiratory holdings (EIO) and three end-expiratory holdings (EEO) were performed. PMIvent was calculated as the difference between plateau pressure (Pplat) within 2 s after EIO and the airway peak pressure (Ppeak) at EIO. PMIref was calculated as the difference between Pplat at one cardiac cycle after EIO and Ppeak at EIO. Flow, airway pressure (Paw), and esophageal pressure (Pes) signals were displayed continuously and saved. PMIref, PMIvent and esophageal pressure time product per breath (PTPes) were measured. PTPes per minute was calculated as the product of PTPes and RR. The “normal” range of PTPes per minute was defined as 50 to 200 cmH2O·s·min-1. The accuracy of PMIvent compared to PMIref was assessed with a Bland-Altman plot. The correlation between PMI and inspiratory effort was evaluated as the coefficient of determination (R²). The ability of PMI to detect high/low effort was assessed using the area under the receiver operating characteristics curve (ROC AUC). The optimal cut-off values were selected based on the Youden index. Results The accuracy and precision of PMIvent compared to PMIref showed a low bias (0.18) with smaller 95% limits of agreements (-0.44,0.80). PMIref was significantly related to the PTPes per minute (between-patients R²=0.61, within-patients R²=0.80, respectively). PMIvent was also related to the PTPes per minute (between-patients R²=0.62, within-patients R²=0.81). For a cut-off PTPes<50 cmH₂O·s·min^-1, PMIvent showed an ROC AUC of 0.93 ［0.89,0.96］, and the best threshold was -0.77 cmH₂O. Conclusion PMIvent can effectively replace PMIref. Like PMIref, PMIvent was significantly related to inspiratory effort and had the potential value to predict low inspiratory effort.

Key words: mechanical ventilation, inspiratory effort, pressure muscle index, esophageal pressure time product

中图分类号:

R459.7

宋德婧, 高然, 杨燕琳, 张琳琳, 周建新. 吸气肌压力指数评价低吸气努力的可行性和有效性[J]. 首都医科大学学报, 2024, 45(2): 194-200.

Song Dejing, Gao Ran, Yang Yanlin, Zhang Linlin, Zhou Jianxin. The feasibility and validity of inspiratory muscle pressure index to assess inspiratory effort[J]. Journal of Capital Medical University, 2024, 45(2): 194-200.

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吸气肌压力指数评价低吸气努力的可行性和有效性

The feasibility and validity of inspiratory muscle pressure index to assess inspiratory effort

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