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Báo cáo khoa học: "Mechanical ventilation in severe asthma"

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: Mechanical ventilation in severe asthma. | Available online http ccforum.eom content 9 6 E29 Letter Mechanical ventilation in severe asthma Randolph P Cole Medical Director of Critical Care Holy Name Hospital Teaneck New Jersey USA Corresponding author Randolph P Cole rc18@columbia.edu Published online 22 November 2005 This article is online at http ccforum.com content 9 6 E29 2005 BioMed Central Ltd Critical Care 2005 9 E29 DOI 10.1186 cc3925 See related review by Stather and Stewart in this issue page 581 http ccforum.com content 9 6 581 In their review on mechanical ventilation in severe asthma Stather and Stewart 1 raise a concern that use of external positive end-expiratory pressure PEEP will result in increased total PEEP and worsened gas trapping 1 . Of critical importance to our understanding of whether application of external PEEP will be beneficial is assessment of the presence or absence of expiratory flow limitation 2 3 . When the severity of airflow obstruction is such that flow limitation is present application of PEEP will not influence expiratory flow or upstream pressures. At the bedside one can examine for this by noting the effect of applied external PEEP on the inflation pressure of subsequent breaths. In the absence of flow limitation increased external PEEP will be transmitted upstream causing parallel increases in alveolar pressure peak airway pressure and end-inspiratory pressure. The associated increase in lung volume will tend to moderate this rise in airway pressure. When flow limitation is present upstream pressures are protected from increases in downstream pressure or PEEP . In this situation inflation pressures are independent of external PEEP. Occasionally inflation pressure may actually decrease with external PEEP. Here the external PEEP may act to stent open the central airways and allow reduction in gas trapping and reduction in end-expiratory lung volumes 4 . Examination of the effect of increasing external PEEP on inflation pressure may allow identification of those .