BACKGROUND:Individualized positive end-expiratory pressure(PEEP)titration is a crucial technique in mechanical ventilation therapy for acute respiratory distress syndrome(ARDS)patients with intra-abdominal hypertensio...BACKGROUND:Individualized positive end-expiratory pressure(PEEP)titration is a crucial technique in mechanical ventilation therapy for acute respiratory distress syndrome(ARDS)patients with intra-abdominal hypertension(IAH).This study aimed to evaluate the eff ectiveness of electrical impedance tomography(EIT)-guided PEEP titration in this population.METHODS:This prospective study enrolled 36 ARDS patients,including 22 patients with IAH and 14 without IAH.All the patients underwent EIT-guided PEEP titration at the intersection point between alveolar overdistension and collapse during a decremental PEEP trial.The changes in pulmonary ventilation distribution,respiratory mechanics and hemodynamics during the titration process were observed.RESULTS:After EIT-guided PEEP titration was performed,the PEEP,peak inspiratory pressure and plateau pressure increased significantly(P<0.05).Furthermore,no significant differences were observed in respiratory system compliance,tidal volume,driving pressure,or the 4*DP+RR index between the two groups(P>0.05).The mechanical power increased in the non-IAH(NIAH)group after PEEP titration(P<0.05).Ventilation in gravity-dependent lung regions significantly increased(P<0.05),and the oxygenation index(PaO2/FiO2)improved signifi cantly(P<0.05)in both groups.However,blood pressure,heart rate,respiratory rate,central venous pressure,and lactate levels did not signifi cantly change.In the IAH group,the PaO2/FiO2 ratio improved less than that in the NIAH group did(P<0.05).CONCLUSION:In our study,individualized PEEP titration guided by EIT improved oxygenation in ARDS patients with concomitant IAH without signifi cantly aff ecting hemodynamics.The presence of IAH may limit the improvement of oxygenation during EIT-guided PEEP titration.展开更多
[目的]基于文献计量学探究植物固土领域的研究热点和趋势,为该领域研究现状和发展提供参考和指导。[方法]以中国知网(CNKI)和Web of Science(WoS)数据库为数据来源,利用VOSviewer和CiteSpace相结合方式对1993-2023年植物固土领域发文量...[目的]基于文献计量学探究植物固土领域的研究热点和趋势,为该领域研究现状和发展提供参考和指导。[方法]以中国知网(CNKI)和Web of Science(WoS)数据库为数据来源,利用VOSviewer和CiteSpace相结合方式对1993-2023年植物固土领域发文量、国家、机构、研究人员、关键词进行可视化分析。[结果](1)发文量呈现出缓慢增长后持续性快速增长,发文量CNKI近年趋于稳定而WoS爆发增长。(2)中国是研究植物固土产出最多的国家,但研究质量仍有提升空间,北京林业大学、云南农业大学、内蒙古农业大学这3家机构是植物固土领域的主要机构,合作发文呈现团队机构内合作紧密,但机构外合作较为缺乏。(3)植物固土领域围绕着边坡稳定性、根系力学、根土抗剪方面开展研究,突现词分析可知,WoS以水土流失预测、黄土高原、机械性能,CNKI以根系形态、消落带、力学特性、自修复以及生态修复为近3 a研究热点。[结论]中国是该领域研究产出最多的国家,但其研究质量和团队机构间的合作交流仍有提升空间,研究植物类型多为草本植物且研究周期较短,未来应加深对其他植物类型和周期的研究,同时研究的生态脆弱地区目前仍旧单一,今后仍需扩大研究区的范围。展开更多
基金PEEP titration in ARDS patients using EIT combined with lung ultrasound,Key Laboratory of Emergency Trauma Research,Ministry of Education (KLET-202201)airway clearance protocol in ICU mechanically ventilated patients based on electrical impedance imaging technology,Natural Science Foundation of Hunan Province (2024JJ9148)effects of end expiratory positive pressure on lung re-expansion in patients with ARDS and intra-abdominal hypertension monitored using lung ultrasound,Natural Science Foundation of Hunan Province (2023JJ60308)
文摘BACKGROUND:Individualized positive end-expiratory pressure(PEEP)titration is a crucial technique in mechanical ventilation therapy for acute respiratory distress syndrome(ARDS)patients with intra-abdominal hypertension(IAH).This study aimed to evaluate the eff ectiveness of electrical impedance tomography(EIT)-guided PEEP titration in this population.METHODS:This prospective study enrolled 36 ARDS patients,including 22 patients with IAH and 14 without IAH.All the patients underwent EIT-guided PEEP titration at the intersection point between alveolar overdistension and collapse during a decremental PEEP trial.The changes in pulmonary ventilation distribution,respiratory mechanics and hemodynamics during the titration process were observed.RESULTS:After EIT-guided PEEP titration was performed,the PEEP,peak inspiratory pressure and plateau pressure increased significantly(P<0.05).Furthermore,no significant differences were observed in respiratory system compliance,tidal volume,driving pressure,or the 4*DP+RR index between the two groups(P>0.05).The mechanical power increased in the non-IAH(NIAH)group after PEEP titration(P<0.05).Ventilation in gravity-dependent lung regions significantly increased(P<0.05),and the oxygenation index(PaO2/FiO2)improved signifi cantly(P<0.05)in both groups.However,blood pressure,heart rate,respiratory rate,central venous pressure,and lactate levels did not signifi cantly change.In the IAH group,the PaO2/FiO2 ratio improved less than that in the NIAH group did(P<0.05).CONCLUSION:In our study,individualized PEEP titration guided by EIT improved oxygenation in ARDS patients with concomitant IAH without signifi cantly aff ecting hemodynamics.The presence of IAH may limit the improvement of oxygenation during EIT-guided PEEP titration.
文摘[目的]基于文献计量学探究植物固土领域的研究热点和趋势,为该领域研究现状和发展提供参考和指导。[方法]以中国知网(CNKI)和Web of Science(WoS)数据库为数据来源,利用VOSviewer和CiteSpace相结合方式对1993-2023年植物固土领域发文量、国家、机构、研究人员、关键词进行可视化分析。[结果](1)发文量呈现出缓慢增长后持续性快速增长,发文量CNKI近年趋于稳定而WoS爆发增长。(2)中国是研究植物固土产出最多的国家,但研究质量仍有提升空间,北京林业大学、云南农业大学、内蒙古农业大学这3家机构是植物固土领域的主要机构,合作发文呈现团队机构内合作紧密,但机构外合作较为缺乏。(3)植物固土领域围绕着边坡稳定性、根系力学、根土抗剪方面开展研究,突现词分析可知,WoS以水土流失预测、黄土高原、机械性能,CNKI以根系形态、消落带、力学特性、自修复以及生态修复为近3 a研究热点。[结论]中国是该领域研究产出最多的国家,但其研究质量和团队机构间的合作交流仍有提升空间,研究植物类型多为草本植物且研究周期较短,未来应加深对其他植物类型和周期的研究,同时研究的生态脆弱地区目前仍旧单一,今后仍需扩大研究区的范围。
