PaCO2 and alveolar dead space are more relevant than PaO2FiO2 ratio in monitoring the respiratory response to prone position in ARDS patients a physiological study 英文参考文献.docVIP

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PaCO2 and alveolar dead space are more relevant than PaO2FiO2 ratio in monitoring the respiratory response to prone position in ARDS patients a physiological study 英文参考文献.doc

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PaCO2 and alveolar dead space are more relevant than PaO2FiO2 ratio in monitoring the respiratory response to prone position in ARDS patients a physiological study 英文参考文献

Charronetal.CriticalCare2011,15:R175 /content/15/4/R175 RESEARCH OpenAccess PaCO2andalveolardeadspacearemorerelevant thanPaO2/FiO2ratioinmonitoringthe respiratoryresponsetopronepositioninARDS patients:aphysiologicalstudy CyrilCharron1,2,XavierRepesse1,2,Koce?laBouferrache1,2,LaurentBodson1,2,SamuelCastro1,2,BernardPage1,2, Fran?oisJardin1,2 andAntoineVieillard-Baron1,2* Abstract Introduction:Ouraimsinthisstudyweretoreportchangesintheratioofalveolardeadspacetotidalvolume (VDalv/VT)intheproneposition(PP)andtotestwhetherchangesinpartialpressureofarterialCO2(PaCO2)maybe morerelevantthanchangesintheratioofpartialpressureofarterialO2tofractionofinspiredO2(PaO2/FiO2 )in definingtherespiratoryresponsetoPP.Wealsoaimedtovalidatearecentlyproposedmethodofestimationof thephysiologicaldeadspace(VDphysiol/VT)withoutmeasurementofexpiredCO2. Methods:ThirteenpatientswithaPaO2/FiO2ratio100mmHgwereincludedinthestudy.Plateaupressure (Pplat),positiveend-expiratorypressure(PEEP),bloodgasanalysisandexpiratoryCO2wererecordedwithpatients inthesupinepositionandafter3,6,9,12and15hoursinthePP.ResponderstoPPweredefinedafter15hours ofPPeitherbyanincreaseinPaO2/FiO2ratio20mmHgorbyadecreaseinPaCO22mmHg.Estimatedand measuredVDphysiol/VTratioswerecompared. Results:PP induced a decrease in Pplat, PaCO2 and VDalv/VT ratio and increases in PaO2/FiO2 ratios and compliance of the respiratory system (Crs). Maximal changes were observed after six to nine hours. Changes in VDalv/VT were correlated with changes in Crs, but not with changes in PaO2/FiO2 ratios. When the response was defined by PaO2/FiO2 ratio, no significant differences in Pplat, PaCO2 or VDalv/VT alterations between responders (n= 7) and nonresponders (n= 6) were observed. When the response was defined by PaCO2,four patients were differently classified, and responders (n= 7) had agreater decrease in VDalv/VT ratio and in Pplat and a greater increase in PaO2/FiO2 ratio and in Crs than nonresponders (n= 6). Estimated VDphysiol/VT ratios sign