Lu Q, Rouby J J
University of Paris VI, Paris, France.
Crit Care. 2000;4(2):91-100. doi: 10.1186/cc662. Epub 2000 Mar 21.
Physiological background concerning mechanics of the respiratory system, techniques of measurement and clinical implications of pressure-volume curve measurement in mechanically ventilated patients are discussed in the present review. The significance of lower and upper inflection points, the assessment of positive end-expiratory pressure (PEEP)-induced alveolar recruitment and overdistension and rationale for optimizing ventilatory settings in patients with acute lung injury are presented. Evidence suggests that the continuous flow method is a simple and reliable technique for measuring pressure-volume curves at the bedside. In patients with acute respiratory failure, determination of lower and upper inflection points and measurement of respiratory compliance should become a part of the routine assessment of lung injury severity, allowing a bedside monitoring of the evolution of the lung disease and an optimization of mechanical ventilation.
本综述讨论了机械通气患者呼吸系统力学的生理背景、测量技术以及压力-容积曲线测量的临床意义。介绍了下拐点和上拐点的意义、呼气末正压（PEEP）诱导的肺泡复张和过度扩张的评估，以及急性肺损伤患者优化通气设置的基本原理。有证据表明，连续气流法是一种在床边测量压力-容积曲线的简单可靠技术。在急性呼吸衰竭患者中，确定下拐点和上拐点以及测量呼吸顺应性应成为评估肺损伤严重程度常规检查的一部分，以便在床边监测肺部疾病的进展并优化机械通气。
