Schultz Marcus J
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Med Sci Monit. 2008 Feb;14(2):RA22-26.
Two randomized controlled trials confirmed the existence of so-called ventilator-associated lung injury by showing reduced morbidity and mortality with the use of lower tidal volumes in patients with acute lung injury (ALI) or its more severe form, acute respiratory distress syndrome (ARDS). While guidelines now strongly advise using lower tidal volumes in ALI/ARDS patients, at present there are no widely agreed upon guidelines for setting tidal volumes in patients who do not suffer from ALI/ARDS. The literature was searched for clinical studies on lung-protective mechanical ventilation using lower tidal volumes in patients not suffering from ALI/ARDS. The best available evidence comes from large retrospective or observational studies which suggest a causal relation between the use of large tidal volumes and the development of lung injury. The inconsistent results from smaller randomized controlled trials, however, do not definitely support the use of lower tidal volumes. The association with potentially injurious ventilator settings, in particular large tidal volumes, suggests that additional lung injury in mechanically ventilated patients without ALI/ARDS is, in part, a preventable complication. Nevertheless, more prospective studies are needed to evaluate optimal ventilator management strategies for patients not suffering from ALI/ARDS.
两项随机对照试验证实了所谓的呼吸机相关性肺损伤的存在，这两项试验表明，在急性肺损伤（ALI）或其更严重形式急性呼吸窘迫综合征（ARDS）患者中，使用较低潮气量可降低发病率和死亡率。虽然目前指南强烈建议在ALI/ARDS患者中使用较低潮气量，但目前对于非ALI/ARDS患者设置潮气量尚无广泛认可的指南。检索文献以查找关于在非ALI/ARDS患者中使用较低潮气量进行肺保护性机械通气的临床研究。现有最佳证据来自大型回顾性或观察性研究，这些研究表明大潮气量的使用与肺损伤的发生之间存在因果关系。然而，较小规模随机对照试验的结果不一致，并不明确支持使用较低潮气量。与潜在有害的呼吸机设置（特别是大潮气量）的关联表明，在没有ALI/ARDS的机械通气患者中发生的额外肺损伤部分是可预防的并发症。尽管如此，仍需要更多前瞻性研究来评估非ALI/ARDS患者的最佳呼吸机管理策略。
