Variabilité ventilatoire et assistance ventilatoire en réanimation View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2014-01

AUTHORS

M. Schmidt, J. Cecchini, F. Kindler, T. Similowski, A. Demoule

ABSTRACT

La ventilation n’est pas un phénomène monotone; elle est au contraire variable dans le temps, non seulement au gré des ajustements homéostasiques aux besoins de l’organisme, mais aussi d’un cycle à l’autre (périodicité dite « anharmonique »). Cette variabilité cycle-à-cycle du volume courant et de ses composantes est liée à la nature complexe, pseudochaotique — au sens mathématique de ces termes — de la dynamique de la commande respiratoire centrale qui génère le débit ventilatoire. Une certaine variabilité respiratoire est synonyme de « bonne santé » respiratoire, et la diminution de la variabilité du comportement ventilatoire est pathologique. Cette diminution peut traduire soit des modifications centrales, soit le « filtrage » de la variabilité de la commande par des modifications de charge mécanique: la complexité du débit ventilatoire et la variabilité cycle-à-cycle de la ventilation sont liées au couplage neuromécanique respiratoire et à l’équilibre charge-capacité. Ainsi, en réanimation, une faible variabilité ventilatoire prédit l’échec du sevrage la ventilation mécanique. Elle est de plus un facteur indépendant de surmortalité. De plus, dans des modèles animaux, l’adjonction artificielle d’une variabilité extrinsèque améliore la mécanique respiratoire et les échanges gazeux. La restauration de la variabilité ventilatoire naturelle par certains modes d’assistance pourrait ainsi s’avérer bénéfique. More... »

PAGES

17-24

Journal

TITLE

Médecine Intensive Réanimation

ISSUE

1

VOLUME

23

Author Affiliations

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s13546-014-0843-z

DOI

http://dx.doi.org/10.1007/s13546-014-0843-z

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1052679472


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