急性呼吸窘迫综合征时PEEP设置：从氧合顺应性到EIT局部呼吸生理指标

doi:10.3877/cma.j.issn.2096-1537.2024.02.002

在急性呼吸窘迫综合征（ARDS）治疗中，关于最佳呼气末正压（PEEP）设置方法一直存在争议。近来越来越多的证据提示目前临床常用的氧合法和最大顺应性法滴定最佳PEEP存在一定局限性，并不能有效地反映区域肺泡复张和过度膨胀。本文主要阐述关于氧合法和顺应性法滴定PEEP局限性的认识进展，进一步提出基于电阻抗成像（EIT）局部呼吸生理指标的“CODP”全流程PEEP管理策略，以期为临床实践提供参考。

关键词: 电阻抗成像, 呼气末正压滴定, 氧合法, 顺应性法

There has been debate on the optimal approach for determining the appropriate positive end-expiratory pressure (PEEP) setting in the treatment of acute respiratory distress syndrome (ARDS). Recently, more and more evidence suggests that the currently used oxygenation and maximum compliance methods for titrating optimal PEEP have certain limitations and cannot effectively reflect regional alveolar recruitment and overexpansion. This article mainly elaborates on the potential misunderstandings of oxygenation and compliance methods for titrating PEEP, and proposes a PEEP setting "CODP" whole strategy based on electrical impedance tomography local respiratory physiology parameters, serving as a guide for clinical practice.

Key words: Electrical impedance tomography, Positive end-expiratory pressure titration, Oxygenation, Compliance

图1 ARDS基于EIT局部呼吸生理的“CODP”PEEP管理策略注：ARDS为急性呼吸窘迫综合征；EIT为电阻抗成像；CODP为Cov、ODCL法、Delta-EELI、Pendulluft；PEEP为呼气末正压；Cov为通气中心；ODCL为过度膨胀塌陷；EELI为呼气末肺电阻抗；GI为用总体不均一；PEEP weaning为PEEP减撤；Pendulluft为钟摆

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PEEP titration in ARDS: from oxygenation and compliance to EIT-guided regional respiratory physiology parameters

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PEEP titration in ARDS: from oxygenation and compliance to EIT-guided regional respiratory physiology parameters