Kacmarek Robert M
Harvard Medical School, Respiratory Care Services, Massachusetts General Hospital, Boston, MA 02114, USA.
Respir Care Clin N Am. 2002 Jun;8(2):187-209. doi: 10.1016/s1078-5337(02)00003-5.
In laboratory models, PLV is clearly more effective than conventional ventilation alone; however, this advantage has not been observed in any human study. The reasons for this are unclear, but the approach to ventilation during PLV may have been inappropriate. HFO may require further study or perhaps PLV should be combined with nitric oxide or some other vasoactive agent. Additionally, perfluorocarbons may need to be aerosolized instead of instilled. Kandler et al. recently demonstrated better gas exchange that was sustained for a longer period in lavage-injured piglets when a perfluorocarbon was aerosolized. This preliminary result demonstrates that there are other options for the delivery of perfluorocarbons in the management of critically ill patients. Based on the failure of the two trials in adult ARDS patients, however, a long time may pass before another human PLV trial is undertaken.
在实验室模型中，肺液体通气显然比单纯的传统通气更有效；然而，在任何人体研究中都未观察到这一优势。其原因尚不清楚，但肺液体通气期间的通气方法可能并不恰当。高频振荡通气可能需要进一步研究，或者肺液体通气应该与一氧化氮或其他血管活性药物联合使用。此外，全氟化碳可能需要雾化而非注入。坎德勒等人最近证明，在灌洗损伤的仔猪中，当全氟化碳雾化时，气体交换更好且能持续更长时间。这一初步结果表明，在危重症患者的管理中，全氟化碳的给药还有其他选择。然而，基于两项针对成人急性呼吸窘迫综合征患者的试验失败，在进行另一项人体肺液体通气试验之前可能还需要很长时间。
