Point Of Care Ultrasound Is Used For Monitoring And Guiding Value To Optimal End Of Breath Pressure In Patients With Acute Respiratory Distress Syndrome

Objective To explore the value of point of care ultrasound for fluid management and monitoring of recruitment manoeuvres in Acute respiratory distress syndrome(ARDS)patients;And further clarify the guiding value of point of care ultrasound for optimal positive end-expiratory pressure(PEEP).Methods Eighty-four ARDS patients admitted to our hospital were selected.The patients were divided into oxygenation group and ultrasound PEEP group by random digital table method,with 42 cases each;The oxygenation group was further divided into conventional group and ultrasound B group,and ultrasound PEEP group was divided into ultrasound A group and ultrasound monitoring group,with 21 cases each in each subgroup.All four groups of patients using PEEP augmentation,conventional group using maximum oxygen legally determine optimal PEEP,central venous pressure guide fluid management,ultrasound A using optimal PEEP,central venous pressure guide fluid management,ultrasound B legally determine optimal PEEP,bedside ultrasound guide fluid management,ultrasound monitoring group using point of care ultrasound guidance to determine optimal PEEP and ultrasound management.Before 4 groups,oxygenation index(after 15min,1h and 2h,PaO2/FiO2),static lung compliance(Clst),dynamic compliance;positive end-expiratory airway pressure(PEEP),acute physiological and chronic health score(APACHE Ⅱ)and Murray lung injury score were collected on the day of admission and 7d of admission.Differences in heart failure,incidence of heart failure,acute renal failure,mechanical ventilation,ICU residence,and 28d fatality in group 4 patients.Results 1.There was no significant difference in sex,age,and disease type in the four groups(P>0.05).2.The oxygenation index(PaO2/FiO2)at 1h and 2h of pulmonary relapse in the ultrasound PEEP group was statistically higher than that in the oxygenated group(P<0.05);the comparison between four subgroups before and after metabolus was not statistically significant(P>0.05),and the oxygenation index(PaO2/FiO2)of patients in the ultrasound monitoring group was higher than that in the conventional group,ultrasound group A,and ultrasound B group.The difference was statistically significant(P<0.05).3,There was no significant difference in Clst between the oxygenation group and the ultrasound PEEP group at different time points(P>0.05).There was no significant difference in Clst between the four subgroups before and 15min after pulmonary recruitment(P>0.05).The Clst of the ultrasound monitoring group was higher than that of the conventional group for 1 hour,and the Clst of the ultrasound monitoring group was higher than that of the conventional group and the ultrasound group A at 2 hours,and the difference was statistically significant(P<0.05).4.Before pulmonary recodilation,dynamic compliance(Cdyn)was not significantly significant(P>0.05);The static lung compliance(Clst)was increased compared with the conventional group,ultrasound A group and ultrasound B group,which showed a statistically significant difference(P<0.05);At 7d of admission,the ultrasound monitoring group was lower than the other three groups(P<0.05);5.Between the oxygenation group,and ultrasound PEEP groups And the APACHE Ⅱ score of the four subgroups at admission(P>0.05);APACHE Ⅱ score of ultrasound PEEP group at 3d was significant(P<0.05);at 7d,ultrasound PEEP group and ultrasound monitoring group were lower than that of oxygenation group and other three groups(P<0.05);6.PEEP was increased between patients in the ultrasound monitoring group at 3d compared with the conventional group and ultrasound B group,which was statistically significant(P<0.05);7.At 7d,the ultrasound monitoring group was lower than the other three groups(P<0.05);8.the Murray lung injury score at 3d was not significant(P>0.05);9.There were no significant comparisons between 7d heart failure,renal failure at 7d(P>0.05)and mechanical ventilation and ICU residence time in the four groups(P<0.05).Conclusion Point of care ultrasound can provide the best PEEP setting for ARDS patients,the subsequent use of bedside intensive ultrasound for pulmonary edema,pulmonary complex monitoring,can improve patient oxygenation index,faster improve patients ’lung static compliance,lung dynamic compliance,reduce lung damage and prognostic risk,lower patients’ mechanical ventilation time and ICU stay time,but still unable to affect patients with heart failure,kidney failure and short-term death risk.