肌肉压力指数与压力支持模式下吸气努力水平的相关性研究：基于ASL5000平台

doi:10.3969/j.issn.1006-7795.2024.02.007

首都医科大学学报

• 重症医学诊疗技术与进展 • 上一篇下一篇

肌肉压力指数与压力支持模式下吸气努力水平的相关性研究：基于ASL5000平台

苗明月^1，2, 苏芮³, 周益民³, 田野³, 杨燕琳³, 张琳琳³, 周建新^1，2*

1.首都医科大学附属北京世纪坛医院重症医学科，北京 100038；2.首都医科大学附属北京世纪坛医院急危重症医学中心，北京 100038；3.首都医科大学附属北京天坛医院重症医学科，北京，100070

收稿日期:2023-12-19 出版日期:2024-04-25 发布日期:2024-04-25
通讯作者: 周建新 E-mail:zhoujx.cn@icloud.com
基金资助:
首都临床诊疗技术研究及转化应用项目(Z201100005520050)，首都医科大学临床与研究中心项目(CMU-2023-45)。

Correlation between pressure muscle index and inspiratory effort levels during pressure support ventilation: based on ASL5000

Miao Mingyue^1，2, Su Rui³, Zhou Yimin³, Tian Ye³, Yang Yanlin³, Zhang Linlin³, Zhou Jianxin^1，2*

1. Department of Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China; 2. Emergency and Critical Care Medical Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China; 3. Department of Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Received:2023-12-19 Online:2024-04-25 Published:2024-04-25
Supported by:
This study was supported by Capital Research and Translational Application of Clinical Diagnosis and Treatment Technology(Z201100005520050), Clinical and Research Center Program of Capital Medical University (CMU-2023-45).

摘要/Abstract

摘要： 目的通过主动模拟肺（ASL5000）模拟吸气努力，评价肌肉压力指数(pressure muscle index, PMI)与反映吸气努力水平指标包括吸气肌肉呼吸做功比例(percent of inspiratory muscle work of breathing, WOBmus%)和吸气肌肉压力-时间积分比例(percent of inspiratory muscle pressure time product, PTPmus%）之间的相关性。方法基于ASL5000平台进行实验设计，模拟50个不同肺模型参数以及25个不同的压力支持(pressure support, PS)水平，共模拟1 250例具有不同自主呼吸水平的患者。通过软件对采集到的流速、气道压和食道压-时间波形数据进行线下分析。使用Spearman相关性分析对PMI和WOBmus%、PTPmus%进行分析。结果不同PMI分组患者之间的PS水平、WOBmus%和PTPmus%差异均有统计学意义。并且随着PMI数值增加，PS水平以及驱动压力逐步下降，呼吸机做功也随之减小。PMI与WOBmus%的Spearman相关系数为0.874（P＜0.001），PMI与PTPmus%的Spearman相关系数为0.875（P＜0.001）。结论 PMI与WOBmus%、PTPmus%之间具有良好相关性，PMI可能是指导PS水平设置的一种无创、有效的指标。关于PMI在不同临床情境下的适用性，及其指导PS水平设置的有效性，未来需要更多的研究进行调查。

关键词: 肌肉压力指数, 吸气努力, 压力支持通气, 主动模拟肺, 相关性

Abstract: Objective To evaluate the correlation between pressure muscle index (PMI) and indicators reflecting inspiratory effort including percent of inspiratory muscle work of breathing (WOBmus%) and percent of inspiratory muscle pressure time product (PTPmus%) by using ASL5000. Methods The study was based on ASL5000, including 1 250 cases of patients with different levels of spontaneous breathing by adjusting 50 different lung model parameters and 25 different pressure support (PS) levels. The data of flow, airway pressure, and esophageal pressure-time waveform were analyzed offline. Spearman correlation analysis was performed on PMI and WOBmus%, PTPmus%. Results The significant differences were observed in PS levels, WOBmus% and PTPmus% among patients in different PMI groups. As PMI increased, PS level and driving pressure gradually decreased, and work of breathing of ventilator (WOBvent) also decreased. The Spearman correlation coefficient between PMI and WOBmus% was 0.874 (P<0.001), and between PMI and PTPmus% was 0.875 (P<0.001). Conclusion PMI shows good correlation between WOBmus% and PTPmus%, suggesting that PMI may be a non-invasive and effective indicator for guiding PS level settings. Further research is needed to investigate the applicability of PMI in different clinical scenarios and its validity in guiding PS level setting.

Key words: pressure muscle index, inspiratory effort, pressure support ventilation, ASL5000, correlation

中图分类号:

苗明月, 苏芮, 周益民, 田野, 杨燕琳, 张琳琳, 周建新. 肌肉压力指数与压力支持模式下吸气努力水平的相关性研究：基于ASL5000平台[J]. 首都医科大学学报, doi: 10.3969/j.issn.1006-7795.2024.02.007.

Miao Mingyue, Su Rui, Zhou Yimin, Tian Ye, Yang Yanlin, Zhang Linlin, Zhou Jianxin. Correlation between pressure muscle index and inspiratory effort levels during pressure support ventilation: based on ASL5000[J]. Journal of Capital Medical University, doi: 10.3969/j.issn.1006-7795.2024.02.007.

参考文献

［1］ Esteban A, Frutos-Vivar F, Muriel A, et al. Evolution of mortality over time in patients receiving mechanical ventilation［J］. Am J Respir Crit Care Med, 2013, 188(2): 220-230.
［2］ Vaporidi K, Akoumianaki E, Telias I, et al. Respiratory drive in critically ill patients. pathophysiology and clinical implications［J］. Am J Respir Crit Care Med, 2020, 201(1): 20-32.
［3］ Goligher E C, Jonkman A H, Dianti J, et al. Clinical strategies for implementing lung and diaphragm-protective ventilation: avoiding insufficient and excessive effort［J］. Intensive Care Med, 2020, 46(12): 2314-2326.
［4］ Tobin M J. Principles and practice of mechanical ventilation［M］. 3rd ed. New York: McGraw Hill Companies, 2013: 199-227.
［5］ Hudson M B, Smuder A J, Nelson W B, et al. Both high level pressure support ventilation and controlled mechanical ventilation induce diaphragm dysfunction and atrophy［J］. Crit Care Med, 2012, 40(4): 1254-1260.
［6］ Esnault P, Cardinale M, Hraiech S, et al. High respiratory drive and excessive respiratory efforts predict relapse of respiratory failure in critically ill patients with COVID-19［J］. Am J Respir Crit Care Med, 2020, 202(8): 1173-1178.
［7］ Akoumianaki E, Maggiore S M, Valenza F, et al. The application of esophageal pressure measurement in patients with respiratory failure［J］. Am J Respir Crit Care Med, 2014, 189(5): 520-531.
［8］ Mauri T, Yoshida T K H, Bellani G, et al. Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives［J］. Intensive Care Med, 2016, 42(9): 1360-1373.
［9］ Telias I, Junhasavasdikul D, Rittayamai N, et al. Airway occlusion pressure as an estimate of respiratory drive and inspiratory effort during assisted ventilation［J］. Am J Respir Crit Care Med, 2020, 201(9): 1086-1098.
［10］ Telias I, Damiani F, Brochard L. The airway occlusion pressure (P0.1) to monitor respiratory drive during mechanical ventilation: increasing awareness of a not-so-new problem［J］. Intensive Care Med, 2018, 44(9): 1532-1535.
［11］ Rittayamai N, Beloncle F, Goligher E C, et al. Effect of inspiratory synchronization during pressure-controlled ventilation on lung distension and inspiratory effort［J］. Ann Intensive Care, 2017, 7(1): 100.
［12］ Roesthuis L, van den Berg M, van der Hoeven H. Non-invasive method to detect high respiratory effort and transpulmonary driving pressures in COVID-19 patients during mechanical ventilation［J］. Ann Intensive Care, 2021, 11(1): 26.
［13］ Bertoni M, Telias I, Urner M, et al. A novel non-invasive method to detect excessively high respiratory effort and dynamic transpulmonary driving pressure during mechanical ventilation［J］. Crit Care, 2019, 23(1): 346.
［14］ Kyogoku M, Shimatani T, Hotz J C, et al. Direction and magnitude of change in plateau from peak pressure during inspiratory holds can identify the degree of spontaneous effort and elastic workload in ventilated patients［J］. Crit Care Med, 2021, 49(3): 517-526.
［15］ Foti G, Cereda M, Banfi G, et al. End-inspiratory airway occlusion: a method to assess the pressure developed by inspiratory muscles in patients with acute lung injury undergoing pressure support［J］. Am J Respir Crit Care Med, 1997, 156(4 Pt 1): 1210-1216.
［16］ Bellani G, Grassi A, Sosio S, et al. Plateau and driving pressure in the presence of spontaneous breathing［J］. Intensive Care Med, 2019, 45(1): 97-98.
［17］ Yang Y L, Liu Y, Gao R, et al. Use of airway pressure-based indices to detect high and low inspiratory effort during pressure support ventilation: a diagnostic accuracy study［J］. Ann Intensive Care, 2023, 13(1): 111.
［18］ Beloncle F, Akoumianaki E, Rittayamai N, et al. Accuracy of delivered airway pressure and work of breathing estimation during proportional assist ventilation: a bench study［J］. Ann Intensive Care, 2016, 6(1): 30.
［19］ Yu C H, Su P L, Lin W C, et al. Simulation of late inspiratory rise in airway pressure during pressure support ventilation［J］. Respir Care, 2015, 60(2): 201-209.
［20］ Vasconcelos R S, Sales R P, Melo L H D P, et al. Influences of duration of inspiratory effort, respiratory mechanics, and ventilator type on asynchrony with pressure support and proportional assist ventilation［J］. Respir Care, 2017, 62(5): 550-557.
［21］ Beloncle F, Piquilloud L, Olivier P Y, et al. Accuracy of P0.1 measurements performed by ICU ventilators: a bench study［J］. Ann Intensive Care, 2019, 9(1): 104.

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肌肉压力指数与压力支持模式下吸气努力水平的相关性研究：基于ASL5000平台

Correlation between pressure muscle index and inspiratory effort levels during pressure support ventilation: based on ASL5000

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