Frank James A, Parsons Polly E, Matthay Michael A
Division of Pulmonary and Critical Care Medicine, University of California-San Francisco, 4150 Clement Street, Mail Stop 111D, San Francisco, CA 94121, USA.
Chest. 2006 Dec;130(6):1906-14. doi: 10.1378/chest.130.6.1906.
For patients with acute lung injury, positive pressure mechanical ventilation is life saving. However, considerable experimental and clinical data have demonstrated that how clinicians set the tidal volume, positive end-expiratory pressure, and plateau airway pressure influences lung injury severity and patient outcomes including mortality. In order to better identify ventilator-associated lung injury (VALI), clinical investigators have sought to measure blood-borne and airspace biological markers of VALI. At the same time, several laboratory-based studies have focused on biological markers of inflammation and organ injury in experimental models in order to clarify the mechanisms of ventilator-induced lung injury (VILI) and VALI. This review summarizes data on biological markers of VALI and VILI from both clinical and experimental studies with an emphasis on markers identified in patients and in the experimental setting. This analysis suggests that measurement of some of these biological markers may be of value in diagnosing VALI and in understanding its pathogenesis.
对于急性肺损伤患者，正压机械通气可挽救生命。然而，大量实验和临床数据表明，临床医生设置潮气量、呼气末正压和平台气道压的方式会影响肺损伤的严重程度以及包括死亡率在内的患者预后。为了更好地识别呼吸机相关性肺损伤（VALI），临床研究人员试图测量VALI的血源性和肺泡腔生物标志物。与此同时，一些基于实验室的研究聚焦于实验模型中的炎症和器官损伤生物标志物，以阐明呼吸机诱发的肺损伤（VILI）和VALI的机制。本综述总结了临床和实验研究中关于VALI和VILI生物标志物的数据，重点关注在患者和实验环境中识别出的标志物。该分析表明，测量其中一些生物标志物可能对诊断VALI及其发病机制具有重要价值。
