Branson Richard D, Johannigman Jay A, Daugherty Elizabeth L, Rubinson Lewis
Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati OH 45267-0558, USA.
Respir Care. 2008 Jan;53(1):78-88; discussion 88-90.
Mechanical ventilation in a situation of mass casualty respiratory failure will require a substantial increase in the capacity for mechanical ventilation, to prevent unnecessary mortality. Concern over the difficulties of treating large numbers of patients with respiratory failure is exceeded only by our lack of experience on which to base decisions. This review evaluates the likely scenarios that could lead to mass casualty respiratory failure and the types of respiratory failure anticipated. A literature review was conducted, using the National Library of Medicine Medical Subject Headings terms "mass casualty respiratory failure," "pandemic flu," "disaster preparedness," and "mass casualty care." Papers were reviewed for relevance to the topic. There is little historical or empirical evidence upon which to base decisions regarding mass casualty respiratory failure and augmenting positive-pressure ventilation capacity. Matching the degree of respiratory impairment anticipated from the most likely mass casualty scenarios allows conclusions to be drawn regarding the performance characteristics of ventilators required for these situations. Little is known about the success of mechanical-ventilator stockpiling for mass casualty respiratory failure. Careful planning with an emphasis on matching ventilator performance to patient need and caregiver skill is critical to appropriate stockpile choices.
在大规模伤亡导致呼吸衰竭的情况下，机械通气需要大幅提高机械通气能力，以防止不必要的死亡。对治疗大量呼吸衰竭患者困难的担忧，仅次于我们缺乏可供决策参考的经验。本综述评估了可能导致大规模伤亡呼吸衰竭的情景以及预期的呼吸衰竭类型。利用美国国立医学图书馆医学主题词“大规模伤亡呼吸衰竭”“大流行性流感”“灾难准备”和“大规模伤亡护理”进行了文献综述。对与该主题相关的论文进行了审查。关于大规模伤亡呼吸衰竭以及增加正压通气能力的决策，几乎没有历史或实证依据。根据最可能发生的大规模伤亡情景所预期的呼吸损害程度，可以得出关于这些情况下所需呼吸机性能特征的结论。对于大规模伤亡呼吸衰竭的机械通气设备储备是否成功，人们知之甚少。强调使呼吸机性能与患者需求及护理人员技能相匹配的精心规划，对于做出合适的储备选择至关重要。
