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Báo cáo khoa học: "Partitioning the work-sparing effects of partial ventilatory support in airflow obstruction"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Partitioning the work-sparing effects of partial ventilatory support in airflow obstruction. | Available online http ccforum.eom content 8 2 101 Commentary Partitioning the work-sparing effects of partial ventilatory support in airflow obstruction John J Marini University of Minnesota Correspondence John J Marini john.j.marini@healthpartners.com Published online 19 February 2004 Critical Care 2004 8 101-102 DOI 10.1186 cc2831 This article is online at http ccforum.com content 8 2 101 2004 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract Sweeping conclusions regarding the utility or nonutility of elevating expiratory pressure are not warranted. The effects of manipulating airway pressure in the setting of airflow obstruction depend heavily on the nature and severity of disease as well as on the presence of airflow limitation during tidal breathing. Keywords airflow obstruction CPAP partial ventilatory support In this issue of Critical Care Miro and colleagues 1 report the results of an experiment designed to determine the relative effects on work of breathing of the inspiratory and expiratory components of applied airway pressure. After a methacholine aerosol was used to induce bronchoconstriction in spontaneously breathing anesthetized dogs equal levels of inspiratory positive airway pressure IPAP expiratory positive airway pressure EPAP and continuous positive airway pressure CPAP were applied and the pressures that developed across the lungs and diaphragm were measured. The authors concluded that any reduction in inspiratory effort attributable to positive pressure during acute bronchospasm is caused primarily by the IPAP component of the airway pressure profile. Although I heartily agree that this interpretation seems correct for the model and conditions they examined I suspect that the implications of this work extend only to a small subset of patients with acute airflow obstruction. Fifteen years have passed since I was asked to write an editorial 2 which was in response to a research paper by Tuxen 3 that failed to show benefit .