Ảnh hưởng của xác định PEEP tối ưu theo cắt lớp phổi điện kháng đến một số chỉ số huyết động trong ARDS ngoại khoa
Nội dung chính của bài viết
Tóm tắt
Nghiên cứu đánh giá ảnh hưởng huyết động của xác định PEEP theo EIT ở người bệnh ARDS trung bình–nặng liên quan chấn thương hoặc hậu phẫu. Thử nghiệm lâm sàng ngẫu nhiên có đối chứng tại Bệnh viện Hữu nghị Việt Đức từ 5/2025 đến 5/2026. Có 125 người bệnh được phân tích, gồm 63 người bệnh nhóm EIT và 62 người bệnh nhóm Chứng. Mức PEEP ở nhóm EIT cao hơn nhóm Chứng tại Ngày 2 và Ngày 3. Không ghi nhận khác biệt về diễn biến theo thời gian giữa hai nhóm đối với nhịp tim, huyết áp tâm thu, huyết áp tâm trương, huyết áp trung bình, lactate máu động mạch, tình trạng sử dụng norepinephrine và liều norepinephrine ở các quan sát có dùng thuốc. Xác định PEEP theo EIT làm thay đổi chiến lược PEEP nhưng không ghi nhận tín hiệu bất lợi huyết động rõ rệt.
Chi tiết bài viết
Từ khóa
ARDS, cắt lớp phổi điện kháng, PEEP, huyết động, ARDS chấn thương, ARDS hậu phẫu
Tài liệu tham khảo
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2. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. Jama. Jun 20 2012; 307(23): 2526-33. doi:10.1001/jama.2012.5669.
3. Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. May 4 2000; 342(18): 1301-8. doi:10.1056/nejm200005043421801.
4. Brower RG, Lanken PN, MacIntyre N, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. Jul 22 2004; 351(4): 327-36. doi:10.1056/NEJMoa032193.
5. Briel M, Meade M, Mercat A, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. Jama. Mar 3 2010; 303(9): 865-73. doi:10.1001/jama.2010.218.
6. Cavalcanti AB, Suzumura É A, Laranjeira LN, et al. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. Jama. Oct 10 2017; 318(14): 1335-1345. doi:10.1001/jama.2017.14171.
7. Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. Feb 19 2015; 372(8): 747-55. doi:10.1056/NEJMsa1410639.
8. Joseph A, Petit M, Vieillard-Baron A. Hemodynamic effects of positive end-expiratory pressure. Curr Opin Crit Care. Feb 1 2024; 30(1): 10-19. doi:10.1097/mcc.0000000000001124.
9. Simon B, Ebert J, Bokhari F, et al. Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. Nov 2012; 73(5 Suppl 4): S351-61. doi:10.1097/TA.0b013e31827019fd.
10. Choudhary S, Pasrija D, Mendez MD. Pulmonary Contusion. StatPearls. StatPearls Publishing Copyright © 2026, StatPearls Publishing LLC.; 2026.
11. Frerichs I, Amato MB, van Kaam AH, et al. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group. Thorax. Jan 2017; 72(1): 83-93. doi:10.1136/thoraxjnl-2016-208357.
12. Costa EL, Borges JB, Melo A, et al. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography. Intensive Care Med. Jun 2009; 35(6): 1132-7. doi:10.1007/s00134-009-1447-y.
13. van der Zee P, Somhorst P, Endeman H, Gommers D. Electrical Impedance Tomography for Positive End-Expiratory Pressure Titration in COVID-19-related Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. Jul 15 2020; 202(2): 280-284. doi:10.1164/rccm.202003-0816LE.
14. He H, Chi Y, Yang Y, et al. Early individualized positive end-expiratory pressure guided by electrical impedance tomography in acute respiratory distress syndrome: a randomized controlled clinical trial. Crit Care. Jun 30 2021; 25(1): 230. doi:10.1186/s13054-021-03645-y.
15. Van Trung D, Giang BTH, Tuan DQ, et al. The impact of PEEP-guided electrical impedance tomography on oxygenation and respiratory mechanics in moderate-to-severe ARDS: a randomized controlled trial. Sci Rep. Nov 29 2025; 16(1): 391. doi:10.1038/s41598-025-29787-5.
16. Songsangvorn N, Xu Y, Lu C, et al. Electrical impedance tomography-guided positive end-expiratory pressure titration in ARDS: a systematic review and meta-analysis. Intensive Care Med. May 2024; 50(5): 617-631. doi:10.1007/s00134-024-07362-2.
17. Becher T, Buchholz V, Hassel D, et al. Individualization of PEEP and tidal volume in ARDS patients with electrical impedance tomography: a pilot feasibility study. Ann Intensive Care. Jun 2 2021; 11(1): 89. doi:10.1186/s13613-021-00877-7.
2. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. Jama. Jun 20 2012; 307(23): 2526-33. doi:10.1001/jama.2012.5669.
3. Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. May 4 2000; 342(18): 1301-8. doi:10.1056/nejm200005043421801.
4. Brower RG, Lanken PN, MacIntyre N, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. Jul 22 2004; 351(4): 327-36. doi:10.1056/NEJMoa032193.
5. Briel M, Meade M, Mercat A, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. Jama. Mar 3 2010; 303(9): 865-73. doi:10.1001/jama.2010.218.
6. Cavalcanti AB, Suzumura É A, Laranjeira LN, et al. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. Jama. Oct 10 2017; 318(14): 1335-1345. doi:10.1001/jama.2017.14171.
7. Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. Feb 19 2015; 372(8): 747-55. doi:10.1056/NEJMsa1410639.
8. Joseph A, Petit M, Vieillard-Baron A. Hemodynamic effects of positive end-expiratory pressure. Curr Opin Crit Care. Feb 1 2024; 30(1): 10-19. doi:10.1097/mcc.0000000000001124.
9. Simon B, Ebert J, Bokhari F, et al. Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. Nov 2012; 73(5 Suppl 4): S351-61. doi:10.1097/TA.0b013e31827019fd.
10. Choudhary S, Pasrija D, Mendez MD. Pulmonary Contusion. StatPearls. StatPearls Publishing Copyright © 2026, StatPearls Publishing LLC.; 2026.
11. Frerichs I, Amato MB, van Kaam AH, et al. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group. Thorax. Jan 2017; 72(1): 83-93. doi:10.1136/thoraxjnl-2016-208357.
12. Costa EL, Borges JB, Melo A, et al. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography. Intensive Care Med. Jun 2009; 35(6): 1132-7. doi:10.1007/s00134-009-1447-y.
13. van der Zee P, Somhorst P, Endeman H, Gommers D. Electrical Impedance Tomography for Positive End-Expiratory Pressure Titration in COVID-19-related Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. Jul 15 2020; 202(2): 280-284. doi:10.1164/rccm.202003-0816LE.
14. He H, Chi Y, Yang Y, et al. Early individualized positive end-expiratory pressure guided by electrical impedance tomography in acute respiratory distress syndrome: a randomized controlled clinical trial. Crit Care. Jun 30 2021; 25(1): 230. doi:10.1186/s13054-021-03645-y.
15. Van Trung D, Giang BTH, Tuan DQ, et al. The impact of PEEP-guided electrical impedance tomography on oxygenation and respiratory mechanics in moderate-to-severe ARDS: a randomized controlled trial. Sci Rep. Nov 29 2025; 16(1): 391. doi:10.1038/s41598-025-29787-5.
16. Songsangvorn N, Xu Y, Lu C, et al. Electrical impedance tomography-guided positive end-expiratory pressure titration in ARDS: a systematic review and meta-analysis. Intensive Care Med. May 2024; 50(5): 617-631. doi:10.1007/s00134-024-07362-2.
17. Becher T, Buchholz V, Hassel D, et al. Individualization of PEEP and tidal volume in ARDS patients with electrical impedance tomography: a pilot feasibility study. Ann Intensive Care. Jun 2 2021; 11(1): 89. doi:10.1186/s13613-021-00877-7.