tailieunhanh - Báo cáo y học: "Ventilation inhomogeneity is one criterion among many in multidimensional PEEP titration."

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Ventilation inhomogeneity is one criterion among many in multidimensional PEEP titration. | Zhao et al. Critical Care 2010 14 424 http content 14 3 424 CRITICAL CARE LETTER L_ Ventilation inhomogeneity is one criterion among many in multidimensional PEEP titration Zhanqi Zhao 1 2 Daniel Steinmann2 Inez Frerichs3 Josef Guttmann2 and Knut Moller See related commentary by Costa and Amato http content 14 2 134 We appreciate the commentary from Dr Costa and Dr Amato 1 on our recent study 2 in which we proposed that ventilation inhomogeneity should be regarded as an additional prospective index along with blood gases lung mechanics and hemodynamics in a multifactorial method to optimize positive end-expiratory pressure PEEP at the bedside. We agree with Costa and Amato that some ventilation heterogeneity may be good 1 . Especially in patients with normal lungs inhomogeneity of lung perfusion and ventilation along the gravity axis match each other - a match that is essential to optimize gas exchange. Little attention was paid however to isogravitational inhomogeneity of pulmonary perfusion and ventilation. When isogravitational inhomogeneity is included in the estimation the influence of gravity is no longer dominant 3 4 . Minimizing the ventilation inhomogeneity during PEEP titration is not intended to eliminate inhomogeneity at all which is impossible by PEEP alone but rather to find a balance between overdistension and atelectasis. Physiological heterogeneity good heterogeneity may be preserved at the selected PEEP level. The global inhomogeneity index 2 can be independently combined with any region-of-interest-definition method if appropriate. Given that no perfect method exists currently for identification of collapsed lung areas by electrical impedance tomography our approach 5 guarantees to include as much of the collapsed lung regions as is detectable in the analysis of ventilation inhomogeneity and provides satisfactory results as shown in a preliminary study by comparison with computed tomography. The titration of PEEP .

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