{"id":25679,"date":"2024-05-08T04:17:00","date_gmt":"2024-05-07T20:17:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25679"},"modified":"2024-05-08T05:40:54","modified_gmt":"2024-05-07T21:40:54","slug":"chest%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e7%97%85%e5%ba%8a%e6%8a%ac%e9%ab%98%e5%af%b9%e8%82%a5%e8%83%96%e4%b8%8e%e4%b8%8d%e8%82%a5%e8%83%96ards%e6%82%a3%e8%80%85%e5%91%bc%e5%90%b8%e5%8a%9b","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25679","title":{"rendered":"[Chest\u53d1\u8868\u8bba\u6587]\uff1a\u75c5\u5e8a\u62ac\u9ad8\u5bf9\u80a5\u80d6\u4e0e\u4e0d\u80a5\u80d6ARDS\u60a3\u8005\u547c\u5438\u529b\u5b66\u7684\u5f71\u54cd"},"content":{"rendered":"\n<p>Critical Care: Original Research<\/p>\n\n\n\n<h1 class=\"wp-block-heading\" id=\"screen-reader-main-title\">Changes in Respiratory Mechanics With Trunk Inclination Differs Between Patients With ARDS With and Without Obesity<\/h1>\n\n\n\n<h3 class=\"wp-block-heading\">Shailesh\u00a0Bihari,\u00a0Ubbo F.\u00a0Wiersema<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\">Chest 2024; 165: 583-589<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\">https:\/\/doi.org\/10.1016\/j.chest.2023.09.032<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"sectitle0010\">Background<\/h3>\n\n\n\n<p id=\"abspara0010\">Studies investigating the effect of trunk inclination on respiratory mechanics in mechanically ventilated patients with&nbsp;<a href=\"https:\/\/www.sciencedirect.com\/topics\/medicine-and-dentistry\/acute-respiratory-distress-syndrome\">ARDS<\/a>&nbsp;have reported postural differences in partition respiratory mechanics. Compared with more upright positions, the supine-flat position provided lower lung and chest wall elastance, allowing reduced driving pressures and end-inspiratory&nbsp;<a href=\"https:\/\/www.sciencedirect.com\/topics\/medicine-and-dentistry\/transpulmonary-pressure\">transpulmonary pressure<\/a>. However, the effect of trunk inclination on respiratory mechanics&nbsp;<a href=\"https:\/\/www.sciencedirect.com\/topics\/medicine-and-dentistry\/inpatient\">in patients<\/a>&nbsp;with obesity and ARDS is uncertain.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"sectitle0015\">Research Question<\/h3>\n\n\n\n<p id=\"abspara0015\">Does the effect of change in posture on partition respiratory mechanics differ between patients with ARDS with and without obesity?<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"sectitle0020\">Study Design and Methods<\/h3>\n\n\n\n<p id=\"abspara0020\">In this single-center study, patients with ARDS with and without obesity were randomized into two 15-minute steps in which trunk inclination was changed from semi-recumbent (40\u00b0 head up) to supine-flat (0\u00b0), or vice versa. At the end of each step partition respiratory mechanics, airway opening pressure and&nbsp;<a href=\"https:\/\/www.sciencedirect.com\/topics\/medicine-and-dentistry\/arterial-blood-gas\">arterial blood gases<\/a>&nbsp;were measured. Paired&nbsp;<em>t<\/em>&nbsp;test was used to examine respiratory mechanics and blood gas variables in each group.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"sectitle0025\">Results<\/h3>\n\n\n\n<p id=\"abspara0025\">Forty consecutive patients were enrolled. Twenty were obese (BMI, 38.4 [34.5-42.3]), and 20 were non-obese (BMI, 26.6 [25.2-28.5]). In the patients with obesity, lung and chest wall elastance, driving pressure, inspiratory transpulmonary pressure, Paco<sub>2<\/sub>, and ventilatory ratio were lower supine than semi-recumbent (<em>P<\/em>\u00a0&lt; .001).\u00a0<a href=\"https:\/\/www.sciencedirect.com\/topics\/medicine-and-dentistry\/airway-resistance\">Airways resistance<\/a>\u00a0was greater supine (<em>P<\/em>\u00a0= .006). In the patients without obesity, only chest wall elastance was lower in supine vs\u00a0semi-recumbent (<em>P<\/em>\u00a0&lt; .001).<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0012369223055642-ga1_lrg.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0012369223055642-gr1_lrg.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0012369223055642-gr2_lrg.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0012369223055642-gr3_lrg.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/ars.els-cdn.com\/content\/image\/1-s2.0-S0012369223055642-gr4_lrg.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"sectitle0030\">Interpretation<\/h3>\n\n\n\n<p id=\"abspara0030\">In mechanically ventilated patients with ARDS and obesity, supine posture provided lower lung and chest wall elastance, and better CO<sub>2<\/sub>&nbsp;clearance, than the semi-recumbent posture.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"sectitle0035\">Clinical Trial Registration<\/h3>\n\n\n\n<p id=\"abspara0035\">This study was registered with Australian New Zealand Clinical Trials Registry (ACTRN12623000794606).<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Critical Care: Original Research Changes in Respiratory [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25679"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25679"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25679\/revisions"}],"predecessor-version":[{"id":25680,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25679\/revisions\/25680"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25679"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25679"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25679"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}