一种可调节呼气末正压的新型高流量气管接口在急性呼吸窘迫综合征体外肺模型中的验证

doi:10.3969/j.issn.1006-5725.2026.09.024

Abstract

Abstract:

Objective High-flow tracheal oxygen （HFTO） often fails to generate effective positive end-expiratory pressure （PEEP） in tracheostomized patients with acute respiratory distress syndrome （ARDS） due to bypassed upper airway resistance. This study evaluated whether a novel high-flow tracheal interface could generate therapeutic PEEP levels and improve pulmonary mechanics in a mechanical lung model of ARDS. Methods In this randomized crossover bench study， an integrated system comprising a high-flow oxygen device， tracheostomy tube， and ARDS-programmed mechanical lung simulator （compliance： 51 mL/cmH?O； resistance： 5.1 cmH?O·s/L） was connected via either the novel or conventional interface. Gas flow was incrementally titrated from 10 to 80 L/min. Primary outcomes included PEEP， functional residual capacity （FRC）， tidal volume （Vt）， and FiO? delivery stability. Results At clinically relevant flow rates （40 ? 60 L/min）， the novel interface generated significantly higher PEEP （3.9 ? 7.3 cmH?O vs. 2.5 ? 5.0 cmH?O， P < 0.001） and FRC （P < 0.01） compared with the conventional interface， with only a modest reduction in Vt. FiO? stability remained comparable between interfaces （P ? 0.05）. PEEP demonstrated a robust power-function relationship with flow rate （R2 = 0.987）， enabling predictable pressure titration. Conclusion By simulating upper airway resistance， the novel high-flow tracheal interface effectively generates therapeutic PEEP levels， potentially facilitating lung recruitment in tracheostomized patients with ARDS.

Key words: high-flow tracheal oxygen, novel high-flow tracheal interface, positive end-expiratory pressure, functional residual capacity, tidal volume, acute respiratory distress syndrome

CLC Number:

R563.8

Anna HOU,Ruonan XU,Fengwei JIAO,Song MI,Liming ZHANG. Validation of a novel high-flow tracheal interface with adjustable positive end-expiratory pressure in an ex vivo lung model of acute respiratory distress syndrome[J]. The Journal of Practical Medicine, 2026, 42(9): 1670-1680.

Figures/Tables 5

Fig.1

Fig.2

Tab.1

Primary and secondary endpoint parameters in the bench experiment"

参数	接口类型	气体流量/(L/min)
参数	接口类型	10	20	30	40	50	60	70	80	P值^※
PEEP/cmH₂O	传统接口	0.4 ± 0.2	0.8 ± 0.2	1.6 ± 0.2	2.5 ± 0.3	3.2 ± 0.3	5.0 ± 0.3	6.1 ± 0.5	7.9 ± 0.6	< 0.001
	新型接口	0.5 ± 0.2	1.0 ± 0.3	2.5 ± 0.2	3.9 ± 0.5	5.1 ± 0.5	7.3 ± 0.5	10.1 ± 0.6	13.4 ± 0.6	< 0.001
	P值^*	0.605	0.233	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
FRC/mL	传统接口	1 502.8 ± 16.3	1 511.7 ± 16.6	1 522.4 ± 16.5	1 537.5 ± 11.6	1 553.4 ± 15.0	1 578.4 ± 19.3	1 604.3 ± 17.9	1 650.7 ± 19.3	< 0.001
	新型接口	1 509.7 ± 14.8	1 519.7 ± 19.9	1 534.6 ± 14.6	1 559.3 ± 13.4	1 588.5 ± 17.4	1 670.5 ± 17.4	1 781.6 ± 15.1	1 963.7 ± 13.2	< 0.001
	P值^*	0.335	0.337	0.096	0.001	< 0.001	< 0.001	< 0.001	< 0.001
Vt/mL	传统接口	235.7 ± 6.3	229.2 ± 6.9	221.3 ± 12.6	216.7 ± 16.8	212.6 ± 7.0	209.1 ± 24.5	208.2 ± 8.5	205.2 ± 7.8	< 0.001
	新型接口	239.3 ± 9.2	227.3 ± 10.2	216.0 ± 21.3	208.6 ± 10.7	198.6 ± 5.9	189.9 ± 10.4	182.9 ± 11.1	178.3 ± 14.9	< 0.001
	P值^*	0.323	0.623	0.514	0.218	< 0.001	0.034	< 0.001	< 0.001
Ptp-EI/cmH₂O	传统接口	8.1 ± 1.0	8.3 ± 1.1	8.6 ± 1.2	9.0 ± 0.9	9.3 ± 0.8	9.7 ± 0.4	10.2 ± 0.9	11.0 ± 0.6	< 0.001
	新型接口	8.3 ± 1.1	8.5 ± 1.1	9.4 ± 0.8	9.8 ± 0.9	10.1 ± 1.4	10.5 ± 0.9	11.9 ± 1.1	14.0 ± 0.8	< 0.001
	P值^*	0.680	0.695	0.110	0.078	0.130	0.031	0.001	< 0.001
Ptp-EE/cmH₂O	传统接口	0.0 ± 0.1	0.1 ± 0.1	0.6 ± 0.1	1.3 ± 0.2	2.2 ± 0.2	3.4 ± 0.3	4.9 ± 0.2	5.7 ± 0.3	< 0.001
	新型接口	0.1 ± 0.1	0.5 ± 0.1	1.4 ± 0.2	2.6 ± 0.2	4.1 ± 0.3	6.2 ± 0.2	7.3 ± 0.3	9.5 ± 0.3	< 0.001
	P值^*	0.003	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
PIP/ cmH₂O	传统接口	-3.5 ± 0.5	-3.1 ± 0.4	-3.0 ± 0.5	-2.6 ± 0.5	-2.3 ± 0.6	-2.2 ± 0.7	-1.9 ± 0.6	-1.6 ± 0.4	< 0.001
	新型接口	-3.6 ± 0.7	-3.0 ± 0.4	-2.5 ± 0.5	-2.2 ± 0.6	-1.9 ± 0.5	-1.3 ± 0.5	-0.9 ± 0.4	-0.5 ± 0.4	< 0.001
	P值^*	0.710	0.497	0.063	0.128	0.154	0.003	< 0.001	< 0.001
PEP/cmH₂O	传统接口	3.4 ± 0.8	3.9 ± 0.6	4.9 ± 0.5	5.3 ± 0.8	6.3 ± 0.5	7.5 ± 0.7	9.0 ± 0.4	10.2 ± 0.8	< 0.001
	新型接口	3.8 ± 0.5	4.9 ± 0.4	6.1 ± 0.4	7.5 ± 0.5	8.3 ± 0.4	10.4 ± 0.6	12.4 ± 0.5	14.8 ± 0.6	< 0.001
	P值^*	0.213	0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
PEIC/cmH₂O	传统接口	-5.0 ± 0.1	-4.9 ± 0.5	-4.8 ± 0.3	-4.8 ± 0.4	-4.7 ± 0.5	-4.7 ± 0.3	-4.6 ± 0.3	-4.2 ± 0.3	< 0.001
	新型接口	-4.8 ± 0.3	-4.7 ± 0.3	-4.7 ± 0.4	-4.6 ± 0.4	-4.4 ± 0.3	-4.0 ± 0.3	-3.7 ± 0.3	-2.6 ± 0.3	< 0.001
	P值^*	0.060	0.353	0.323	0.304	0.043	< 0.001	< 0.001	< 0.001
PEEC/cmH₂O	传统接口	-0.1 ± 0.1	-0.1 ± 0.1	0.0 ± 0.0	0.1 ± 0.1	0.2 ± 0.1	0.3 ± 0.1	0.5 ± 0.1	0.8 ± 0.1	< 0.001
	新型接口	-0.1 ± 0.1	0.0 ± 0.2	0.1 ± 0.1	0.2 ± 0.1	0.4 ± 0.1	0.9 ± 0.1	1.5 ± 0.1	2.3 ± 0.1	< 0.001
	P值^*	0.809	0.308	< 0.001	0.001	< 0.001	< 0.001	< 0.001	< 0.001
FiO₂/%	传统接口	34.8 ± 1.1	37.7 ± 1.3	42.7 ± 1.7	45.0 ± 2.2	47.2 ± 1.7	47.8 ± 2.2	48.3 ± 2.5	48.2 ± 1.9	< 0.001
	新型接口	35.4 ± 1.2	38.7 ± 3.0	43.7 ± 2.1	46.2 ± 2.1	47.8 ± 2.4	48.1 ± 2.5	48.6 ± 2.1	49.0 ± 2.5	< 0.001
	P值^*	0.277	0.349	0.231	0.237	0.545	0.760	0.763	0.469

Tab.1

Fig.3

Fig.4

References 43

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Validation of a novel high-flow tracheal interface with adjustable positive end-expiratory pressure in an ex vivo lung model of acute respiratory distress syndrome

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