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中华重症医学电子杂志 ›› 2024, Vol. 10 ›› Issue (04) : 394 -398. doi: 10.3877/cma.j.issn.2096-1537.2024.04.014

综述

气道闭合的监测在机械通气中的研究进展
刘婷1, 杨少康1, 陈亿霏1, 刘悦1, 潘纯2,()   
  1. 1.210009 南京,江苏省重症医学重点实验室 东南大学附属中大医院重症医学科
    2.610072 成都,四川省医学科学院 四川省人民医院重症医学中心
  • 收稿日期:2024-02-24 出版日期:2024-11-28
  • 通信作者: 潘纯

Progress in the monitoring of airway closure in mechanical ventilation

Ting Liu1, Shaokang Yang1, Yifei Chen1, Yue Liu1, Chun Pan2,()   

  1. 1.Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009,China
    2.Sichuan Academy of Medical Sciences, Critical Care Medicine Center, Sichuan People’s Hospital,Chengdu 610072, China
  • Received:2024-02-24 Published:2024-11-28
  • Corresponding author: Chun Pan
引用本文:

刘婷, 杨少康, 陈亿霏, 刘悦, 潘纯. 气道闭合的监测在机械通气中的研究进展[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 394-398.

Ting Liu, Shaokang Yang, Yifei Chen, Yue Liu, Chun Pan. Progress in the monitoring of airway closure in mechanical ventilation[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(04): 394-398.

气道闭合是由于气道塌陷导致气道和肺泡之间连接中断,其发生率约为30%,在肥胖合并急性呼吸窘迫综合征(ARDS)患者中的发生率更可高达65%。“液体桥形成”“小气道顺应性塌陷”“表面活性物质耗竭”等均可导致气道闭合,但确切机制尚不清楚。气道闭合不仅影响肺通气功能,在机械通气过程中,忽略此现象还会造成肺可复张性评估及呼吸力学测定错误,从而影响呼吸机参数的恰当设置,甚至可导致或加重肺损伤,对基于心肺交互作用的容量反应性评估指标也可产生一定影响。临床上可通过“低流速法”或“传导压力法”对气道闭合现象进行监测。本文围绕气道闭合现象及其对呼吸和循环的影响进行综述,强调监测气道闭合的重要性,以加深临床医师对气道闭合的认识,从而改善存在气道闭合的机械通气患者的预后。

Airway closure refers to a lack of communication between proximal airways and alveoli due to airway collapse.It occurs in about 30% of patients, rising to up to 65% of patients with obesity and ARDS.“Liquid bridge formation,” “small airway compliant collapse,” or “surfactant depletion” can lead to airway closure, however, the exact mechanism is unknown.Airway closure not only affects the function of lung ventilation, but also in the process of mechanical ventilation, ignoring this phenomenon can lead to errors in lung recruitment assessment and respiratory mechanics measurement.This can affect the appropriate setting of ventilator parameters, even leading to or aggravating lung injury, and impacting on the fluid responsiveness assessment index based on heart-lung interaction.Airway closure can be monitored clinically by “low flow method” or “conductive pressure method”.This article reviews the phenomenon of airway closure and its impacts on respiration and circulation, emphasizing the importance of monitoring airway closure to deepen clinicians’ understanding and thereby improve the prognosis of mechanically ventilated patients with airway closure.

图1 低流速法检测气道闭合现象。图示患者气道开放压为8.0 cmH2O(1 cmH2O=0.098 kPa)
图2 传导压力法检测气道闭合现象。AOP= PEEP+(Pcond-Pres) 注:AOP 为气道开放压;PEEP 为呼气末正压;Pcond 为传导压力;Pres 为阻力压力
1
Dollfuss RE, Milic-Emili J, Bates DV.Regional ventilation of the lung,studied with boluses of 133xenon [J].Resp Physiol, 1967, 2: 234-246.
2
Chen L, Del Sorbo L, Grieco DL, et al.Airway closure in acute respiratory distress syndrome: an underestimated and misinterpreted phenomenon [J].Am J Respir Crit Care Med, 2018, 197(1): 132-136.
3
Sun XM, Chen GQ, Zhou YM, et al.Airway closure could be confirmed by electrical impedance tomography [J].Am J Respir Crit Care Med, 2018, 197(1): 138-141.
4
Nakayama R, Bunya N, Takeuchi M, et al.Possible overestimation of chest wall driving pressure and underestimation of airway closure [J].Intensive Care Med, 2023, 49(2): 258-259.
5
Pan C, Chen L, Lu C, et al.Lung recruitability in COVID-19-associated acute respiratory distress syndrome: a single-center observational study[J].Am J Respir Crit Care Med, 2020, 201(10): 1294-1297.
6
Chen L, Del Sorbo L, Grieco DL, et al.Potential for lung recruitment estimated by the recruitment-to-inflation ratio in acute respiratory distress syndrome.A clinical trial [J].Am J Respir Crit Care Med,2020, 201(2): 178-187.
7
Borges JB.The plausibility of “bronchiolotrauma” [J].Am J Respir Crit Care Med, 2018, 197(8): 1086-1087.
8
Junhasavasdikul D, Telias I, Grieco DL, et al.Expiratory flow limitation during mechanical ventilation [J].Chest, 2018, 154(4): 948-962.
9
Blanco-Schweizer P, Ángel de Ayala-Fernández J, Blanco J.Estimating airway opening pressure, trapped gas volume, and hidden intrinsic positive end-expiratory pressure in mechanically ventilated patients [J].Ann Am Thorac Soc, 2021, 18(2):356-360.
10
Pozzi M, Cominesi DR, Giani M, et al.Airway closure in patients with cardiogenic pulmonary edema as a cause of driving pressure overestimation: the “uncorking effect” [J].Chest, 2023, 164(5): e125-e130.
11
Grieco DL, Anzellotti GM, Russo A, et al.Airway closure during surgical pneumoperitoneum in obese patients [J].Anesthesiology, 2019,131(1): 58-73.
12
Grieco DL, Russo A, Anzellotti GM, et al.Lung-protective ventilation during Trendelenburg pneumoperitoneum surgery: a randomized clinical trial [J].J Clin Anesth, 2023, 85: 111037.
13
Coudroy R, Vimpere D, Aissaoui N, et al.Prevalence of complete airway closure according to body mass index in acute respiratory distress syndrome [J].Anesthesiology, 2020, 133(4): 867-878.
14
Rozé H, Boisselier C, Bonnardel E, et al.Electrical impedance tomography to detect airway closure heterogeneity in asymmetrical acute respiratory distress syndrome [J].Am J Respir Crit Care Med,2021, 203(4): 511-515.
15
Heil M, Hazel AL, Smith JA.The mechanics of airway closure [J].Respir Physiol Neurobiol, 2008, 163(1-3): 214-221.
16
Halpern D, Grotberg JB.Surfactant effects on fluid-elastic instabilities of liquid-lined flexible tubes: a model of airway closure [J].J Biomech Eng, 1993, 115(3): 271-277.
17
Broche L, Pisa P, Porra L, et al.Individual airway closure characterized in vivo by phase-contrast CT imaging in injured rabbit lung [J].Crit Care Med, 2019, 47(9): e774-e781.
18
Coudroy R, Lu C, Chen L, et al.Mechanism of airway closure in acute respiratory distress syndrome: a possible role of surfactant depletion [J].Intensive Care Med, 2019, 45(2): 290-291.
19
Hedenstierna G, Chen L, Brochard L.Airway closure, more harmful than atelectasis in intensive care? [J].Intensive Care Med, 2020,46(12): 2373-2376.
20
Borges JB, Costa EL, Suarez-Sipmann F, et al.Early inflammation mainly affects normally and poorly aerated lung in experimental ventilatorinduced lung injury [J].Crit Care Med, 2014, 42(4): e279-e287.
21
Gattinoni L, Caironi P, Cressoni M, et al.Lung recruitment in patients with the acute respiratory distress syndrome [J].N Engl J Med, 2006,354(17): 1775-1786.
22
Jonson B, Richard JC, Straus C, et al.Pressure-volume curves and compliance in acute lung injury: evidence of recruitment above the lower inflection point [J].Am J Respir Crit Care Med, 1999, 159(4 Pt 1):1172-1178.
23
Chiumello D.Bedside ultrasound assessment of positive end expiratory pressure-induced lung recruitment [J].Am J Respir Crit Care Med, 2012, 185(4): 457; author reply 457-458.
24
Jonkman AH, Alcala GC, Pavlovsky B, et al; Pleural Pressure Working Group (PLUG).Lung recruitment assessed by electrical impedance tomography (RECRUIT): a multicenter study of COVID-19 acute respiratory distress syndrome [J].Am J Respir Crit Care Med, 2023,208(1): 25-38.
25
De Jong A, Cossic J, Verzilli D, et al.Impact of the driving pressure on mortality in obese and non-obese ARDS patients: a retrospective study of 362 cases [J].Intensive Care Med, 2018, 44(7): 1106-1114.
26
Haudebourg AF, Moncomble E, Lesimple A, et al.A novel method for assessment of airway opening pressure without the need for low-flow insufflation [J].Crit Care, 2023, 27(1): 273.
27
Rezoagli E, Pozzi M, Cereda M, et al.Overestimation of driving pressure by the analysis of the conductive pressure during venous-arterial ECMO:airway closure or intrinsic PEEP? [J].Crit Care, 2023, 27(1): 497.
28
Teboul JL, Monnet X, Chemla D, et al.Arterial pulse pressure variation with mechanical ventilation [J].Am J Respir Crit Care Med,2019, 199(1): 22-31.
29
Beloncle FM, Richard JC, Merdji H, et al.Advanced respiratory mechanics assessment in mechanically ventilated obese and non-obese patients with or without acute respiratory distress syndrome [J].Crit Care, 2023, 27(1): 343.
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