Department of Anesthesiology, Surgery and Neurosurgery, USA.
Curr Opin Anaesthesiol. 2010 Apr;23(2):228-32. doi: 10.1097/ACO.0b013e328336ea6e.
The purpose of this review is to evaluate new concepts in mechanical ventilation in trauma. We begin with the keystone of physiology prior to embarking on a discussion of several new modes of mechanical ventilation. We will discuss the use of noninvasive ventilation as a mode to prevent intubation and then go on to airway pressure release ventilation, high-frequency oscillatory ventilation, and computer-based, closed loop ventilation.
The importance of preventing further injury in mechanical ventilation lies at the heart of the introduction of several new strategies of mechanical ventilation. New modes of ventilation have been developed to provide lung recruitment and alveolar stabilization at the lowest possible pressure.
The old modes of continuous positive airway pressure and bilevel positive airway pressure have been actively introduced in clinical practice in the case of trauma patients. Used with proper pain management protocols, there has been a decrease in the incidence of intubation in blunt thoracic trauma. Airway pressure release ventilation has been gaining a role in the management of thoracic injury and may lead to less incidence of physiologic trauma to mechanically ventilated patients. High-frequency oscillatory ventilation has been shown to be effective in patient care by its ability to open and recruit the lung in trauma patients and in those with acute respiratory distress syndrome but it may not have a role in patients with inhalational injury. Closed loop ventilation is a technology that may better control major pulmonary parameters and lead to more rapid titration from the ventilator to spontaneous breathing.
本综述旨在评估创伤中机械通气的新概念。我们从生理学的基石开始，然后讨论几种新的机械通气模式。我们将讨论使用无创通气作为预防插管的模式，然后继续介绍气道压力释放通气、高频振荡通气和基于计算机的闭环通气。
在机械通气中防止进一步损伤的重要性是引入几种新的机械通气策略的核心。已经开发了新的通气模式，以在尽可能低的压力下提供肺复张和肺泡稳定。
在创伤患者中，传统的持续气道正压通气和双水平气道正压通气模式已被积极引入临床实践。结合适当的疼痛管理方案，钝性胸部创伤患者的插管发生率有所下降。气道压力释放通气在胸部损伤的治疗中发挥着作用，可能会减少机械通气患者的生理创伤发生率。高频振荡通气因其能够在创伤患者和急性呼吸窘迫综合征患者中打开和募集肺部的能力而被证明在患者护理中有效，但在吸入性损伤患者中可能没有作用。闭环通气是一种可以更好地控制主要肺部参数并更快地从呼吸机过渡到自主呼吸的技术。
