The Clinical Evaluation Of EIT In Prone Position Ventilationand Different PEEP After Lung Recruitment In Acute Respiratory Distress Syndrome

Object:To observation the effect of the Prone Position Ventilation and different PEEP after lung recruitment in early acute respiratory distress syndrome.Method:We selected 50 patients with early acute respiratory distress syndrome as the object of study from EICU of The First Affiliated Hospital of Kunming Medical University, there are 31 male,19 female,age 18-75 years old, APACHE-II score>15, with sedation and analgesia treatment post admission,and the mechanical ventilation time> 24h.Conventional prone position ventilation every day(30min).Ventilator Parameters and model:SIMV, tidal volume 6～8 ml/kg, PEEP 6-10cmH2O,tinsp 25%, inspiratory pause time 0.2s, respiratory rate 20 Time per minute, adjust the inhaled oxygen concentration(Fi02),in order to ensure SpO2>90%.Based on mechanical ventilation,for Prone position ventilation,and different PEEP, arterial blood gas tests after 15 minutes,and record Oxygenation index、heart rate、systolic pressure、mean arterial pressure、respiratory rate at al.The patients are grouped in accordance with the principle of randomization, Group A just Prone Position Ventilation,Group B plus PEEP10cmH2O, Group C plus PEEP20cm H2O,Group D plus PEEP30cm H2O, Group E plus PEEP40cm H2O. In order to observe efficacy and safety after lung recruitment with different PEEP.Results:1、Five groups of patients had no statistical difference in age,weight,and APACHE-Ⅱ score (P>0.05)2. Oxygenation index:E>D>C>B>A (P<0.01)EIT:The alveolar openness of Group A is the least,the other Group E is the most. (P<0.05)CT:The alveolar openness of Group A is the least,the other Group E is the most. (P<0.05)Mean arterial pressure:Group E is the lowest (P<0.05)3、EIT has the has the positive correlation with Oxygenation index (P< 0.001, r=0.745)conclusion:1、As PEEP increases what happens is that the Oxygenation index actually increases, the pulmonary consolidation can promote recruitment maneuvers obviously.When PEEP reaching a certain level, the pulmonary consolidation can not promote recruitment maneuvers obviously.Hemodynamics tends to be unstable.2、As PEEP increases what happens is that mean arterial pressure degrees.PEEP changes will affect the stability of hemodynamics.3、EIT can judge the lungs as an effective indicator of lung recruitment.