| Background:Acute respiratory distress syndrome is very common and the mortality is very high in the ICU patients. Low tidal volume and the open lung strategy do good to the prognosis. A suitable PEEP is important for the ARDS patients. But it is very hard to choose a suitable PEEP. Electrical impedance tomography is a new way which can reflect the changes of pulmonary ventilation through the changes of regional lung tissue electrical impedance. The purpose of the study is to know the effect of the gas distribution directed PEEP on gas distribution, respiration mechanics, gas exchange and hemodynamics mechanics.Objective:To observe the effects of gas distribution directed PEEP titration on oxygenation, respiratory mechanics and hemodynamic in patients with ARDS.Methods:Prospective repeated measurement of crossover design study. Bring mechanical ventilation patients with ARDS into the research, basic ventilation for 30 minutes. Set the PEEP by ARDSnet. Recruitment manoeuvres with pressure control ventilation until it is the maximum recruitment. Then ventilating in a decremental positive end-expiratory pressure(PEEP)trial that was reduced from 20 to 6 cmH20 after full lung recruitment Respiratory mechanics,blood gases,hemodynamic data and gas distribution data by EIT were recorded at each PEEP level. What we need to know is the best PEEP directed by different ways and effects of gas distribution directed PEEP titration on oxygenation, respiratory mechanics and hemodynamic in patients with ARDS.Results:a) The general situation:11 patients were includedwho were from intensive care unit of Southeast university affiliated zhongda hospital, APACHE Ⅱ score is 23±9, 10 are Pulmonary interior,1 is exterior reason caused.b) Contrast of Different methods of PEEP titration:PEEPGI was 12.2±3.4 cmH20; PEEPARDSnet was 9.1±2.4 cmH2O; PEEPcrs was 12.4±2.9 cmH2O; PEEPptp was 11.8±4.7 cmH20. PEEPARDSnet was lower than PEEPGI, PEEPCrs and PEEPPtp (P<0.05)c) The impact on the gas distribution of different ways to titrate PEEP:Compared with the GI(0.36±0.06)of GI-PEEP, the GI(0.43±0.09)of Crs-PEEP reduced significantly (p<0.05);Compared with the △ Z%ROIl (0.12±0.06) of ARDSnet-PEEP,the △Z%ROI1(0.10±0.056)of GI-PEEP reduced significantly (p<0.05). Compared with the △Z%ROIl、△Z%ROI2、△Z%ROI3、△Z%ROI4、△Z%ROIl+2、 △Z%ROI3+4 of Oxy-PEEP、Crs-PEEP、Ptp-PEEP, the gas distribution were no statistically significant difference (p>0.05)d) The impact on the respiratory mechanics of different ways to titrate PEEP: Compared with the Ptrans-insp (15.6±6.9cmH2O) of ARDSnet-PEEP and the Ptrans-insp (14.7±5) of Ptp-PEEP, the Ptrans-insp (18.3±7.4cmH2O) of GI-PEEP increased significantly (p<0.05). There was no statistically significant difference between the other respiratory mechanics indicators (p> 0.05)e) The impact on the gas exchange of the gas distribution ways to titrate PEEP: Compared with ARDSnet -PEEP、Crs-PEEP. Ptp-PEEP, There was no statistically significant difference between pH、PaO2、PaCO2 (p>0.05)f) The impact on the hemodynamics of the gas distribution ways to titrate PEEP: Compared with CVP(9.5±3.9mmHg)of ARDSnet-PEEP, CVP(10.5±4.3mmHg) of GI-PEEP increased significantly (p<0.05). There was no statistically significant difference between the other hemodynamics (p> 0.05)Conclusion:Our study demonstrates the ways of GI gas distribution PEEP titration can decrease the inhomogeneity of the lung, and has no effect on oxygenation, and hemodynamic compared with the others ways, transpulmonary pressure ways. But the Ptrans-insp is higher than ARDSnet-PEEP and Ptp-PEEP. |
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