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Application of continuous positive airway pressure to trace static pressure-volume curves of the respiratory system

 

作者: Guillermo,   Albaiceta Enrique,   Piacentini Ana,   Villagrá Josefina,   Lopez-Aguilar Francisco,   Taboada Lluis,  

 

期刊: Critical Care Medicine  (OVID Available online 2003)
卷期: Volume 31, issue 10  

页码: 2514-2519

 

ISSN:0090-3493

 

年代: 2003

 

出版商: OVID

 

关键词: mechanical ventilation;pressure-volume curves;continuous positive airway pressure;positive end-expiratory pressure;acute lung injury

 

数据来源: OVID

 

摘要:

ObjectiveTo evaluate a new technique for pressure-volume curve tracing.DesignProspective experimental study.SettingAnimal research laboratory.SubjectsSix anesthetized rats.InterventionsTwo pressure-volume curves were obtained by means of the super-syringe method (gold standard) and the continuous positive airway pressure (CPAP) method. For the CPAP method, the ventilator was switched to CPAP and the pressure level was raised from 0 to 50 cm H2O in 5 cm H2O steps and then decreased, while we measured lung volume using respiratory inductive plethysmography. Thereafter, lung injury was induced using very high-volume ventilation. Following injury, two further pressure-volume curves were traced. Pressure-volume pairs were fitted to a mathematical model.Measurements and Main ResultsPressure-volume curves were equivalent for each method, with intraclass correlation coefficients being higher than .75 for each pressure level measured. Bias and precision for volume values were 0.46 ± 0.875 mL in basal measurements and 0.31 ± 0.67 mL in postinjury conditions. Lower and upper inflection points on the inspiratory limb and maximum curvature point on the deflation limb obtained using both methods and measured by regression analysis also were correlated, with intraclass correlation coefficients (95% confidence interval) being .97 (.58, .99), .85 (.55, .95), and .94 (.81, .98) (p< .001 for each one). When inflection points were estimated by observers, the correlation coefficient between methods was .90 (.67, .98) for lower inflection points (p< .001). However, estimations for upper inflection points and maximum curvature point were significantly different.ConclusionsThe CPAP method for tracing pressure-volume curves is equivalent to the super-syringe method. It is easily applicable at the bedside, avoids disconnection from the ventilator, and can be used to obtain both the inspiratory and the deflation limbs of the pressure-volume curve. Use of regression techniques improves determination of inflection points.

 

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