Prinianakis George, Kondili Eumorfia, Georgopoulos Dimitris
Department of Intensive Care, University Hospital, University of Crete School of Medicine, PO Box 1352, Heraklion 71110, Crete, Greece.
Respir Care Clin N Am. 2005 Jun;11(2):201-24. doi: 10.1016/j.rcc.2005.02.007.
During assisted mechanical ventilation, the total pressure applied to respiratory system is the sum of ventilator and muscle pressure. As a result, the respiratory system is under the influence of two pumps, the ventilator pump (ie, Paw), which is controlled by the physician's brain and the capabilities of the ventilator, and the patient's own respiratory muscle pump (Pmus), which is controlled by the patient's brain. The patient-ventilator interaction is mainly an expression of the function of these two brains, which should be in harmony to promote patient-ventilator synchrony. The achievement of this harmony depends exclusively on the physician, who should be aware that during assisted mechanical ventilation the respiratory system is not a passive structure but reacts to pressure delivered by the ventilator via various feedback systems and, depending on several factors both to the ventilator and patient, may modify the function of the ventilator. Finally, the physician should know that the ventilator imposes significant constraints to the respiratory system, the magnitude of which depends heavily on the triggering variable, the variable that controls the gas delivery and the cycling off criterion.
在机械辅助通气期间，施加于呼吸系统的总压力是呼吸机压力和肌肉压力之和。因此，呼吸系统受到两个泵的影响，即由医生的大脑和呼吸机功能控制的呼吸机泵（即气道压力），以及由患者大脑控制的患者自身呼吸肌泵（肌肉压力）。患者与呼吸机的相互作用主要是这两个“大脑”功能的体现，二者应协调一致以促进患者与呼吸机的同步。这种协调性的实现完全取决于医生，医生应意识到在机械辅助通气期间，呼吸系统并非被动结构，而是会通过各种反馈系统对呼吸机输送的压力做出反应，并且根据呼吸机和患者的多种因素，可能会改变呼吸机的功能。最后，医生应该知道，呼吸机对呼吸系统施加了重大限制，其程度在很大程度上取决于触发变量、控制气体输送的变量以及切换标准。
