Tuberculosis and Respiratory Diseases

  • 제57권6호
  • /
  • Pages.567-572
  • /
  • 2004
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  • 1738-3536(pISSN)
  • /
  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
권호 표지

자가 호기말 양압(auto-PEEP)을 보인 환자에서 원인질환에 따른 PEEP적용 효과의 차이

Different PEEP Effects on Lung Volume According to Underlying Lung Disease in Patients with Auto-PEEP

  • 손장원 (한양대학교 의과대학 내과학교실) ;
  • 고윤석 (울산대학교 의과대학, 서울아산병원 호흡기내과학교실)
  • Sohn, Jang Won (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Koh, Younsuck (Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2004.10.03
  • 심사 : 2004.11.23
  • 발행 : 2004.12.30
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초록

배 경 : 인공 호흡기 치료 중 auto-PEEP을 보이는 환자에게 PEEP을 적용할 경우에 폐 용적에 미치는 영향은 일정하지 않다. COPD와 같이 동적 호기류 제한이 있는 경우에 auto-PEEP 수치의 85%에 해당하는 PEEP까지는 안전하게 적용할 수 있으나, 동적 호기류 제한이 없으면 낮은 PEEP에서도 폐 용적의 증가가 나타난다. 이에 저자들은 auto-PEEP이 있는 환자에서 임상진단에 의한 질환별로 PEEP적용의 효과에 차이가 있는지 보고자 하였다. 대상 및 방법 : 인공 호흡 중 auto-PEEP을 보인 환자 16명을 대상으로 병력, 임상 증상 및 흉부방사선 소견을 기준으로 천식, COPD, 결핵성 변화군 등 3가지 환자 군으로 분 류한 뒤 각각 auto-PEEP 수치의 25, 50, 75, 100%에 해당하는 PEEP을 적용하고 포획 가스용적을 측정하여 폐 용적의 증가를 비교하였다. 결 과 : 천식 환자 군에서는 75% PEEP부터 폐 용적의 증가가 의미 있게 나타났다. COPD 군에서는 100% PEEP에서 폐 용적이 증가 하였다. 결핵성 변화 군에서는 낮은 PEEP에서도 폐 용적이 증가하는 경향을 보였으나 통계적으로 의미 있는 증가는 100% PEEP에서만 나타났다. 결 론 : Auto-PEEP을 보이는 환자에서 폐 용적에 대한 PEEP의 효과는 폐의 병리 상태에 따라 달랐다. 천식 환자 군에서는 auto-PEEP 수치의 50%이상에 해당하는 PEEP 적용은 포획 가스 용적의 증가를 가져올 수 있다.

Background : The effect of PEEP(ed note: Define PEEP.) on the lung volume in patients with auto-PEEP during mechanical ventilation is not even. In patients with an expiratory limitation such as COPD, a PEEP of 85% from an auto-PEEP can be used with minimal increase in the lung volume. However, the application of PEEP to patients without an expiratory flow limitation can result in progressive lung. This study was carried out to evaluate the different PEEP effects on the lung volume according to the different pulmonary diseases. Methods : Sixteen patients who presented with auto-PEEP during mechanical ventilation were enrolled in this study. These patients were divided into 3 groups: asthma, COPD and tuberculosis sequela (patients with severe cicatrical fibrosis as a result of previous tuberculosis and compensatory emphysema). A PEEP of 25, 50, 75 and 100% of the auto-PEEP was applied, and the lung volume increments were estimated using the trapped lung volume. Results : In the asthma group, the trapped lung volume was not increased at a PEEP of 25 and 50% of the auto-PEEP. This group showed a significant lung volume increment from a 75% PEEP. In the COPD group, the lung volume was increased only at 100% PEEP. In the tuberculosis sequela group, the lung volume was increased progressively from low PEEP levels. However, a significant increment of the lung volume was noted only at 100% PEEP. Conclusion : The effects of the applied PEEP on the lung volume were different depending on the underlying lung pathology. The level of the applied PEEP >50% of the auto-PEEP might increase the trapped lung volume in patients with asthma.

키워드

참고문헌

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