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在肺保护性通气中,压力目标设定有获益或危害吗?

Are there benefits or harm from pressure targeting during lung-protective ventilation?

机构信息

Division of Pulmonary and Critical Care Medicine, Duke University Hospital, Box 3911, Durham NC 27710, USA.

出版信息

Respir Care. 2010 Feb;55(2):175-80; discussion 180-3.

Abstract

Mechanically, breath design is usually either flow/volume-targeted or pressure-targeted. Both approaches can effectively provide lung-protective ventilation, but they prioritize different ventilation parameters, so their responses to changing respiratory-system mechanics and patient effort are different. These different response behaviors have advantages and disadvantages that can be important in specific circumstances. Flow/volume targeting guarantees a set minute ventilation but sometimes may be difficult to synchronize with patient effort, and it will not limit inspiratory pressure. In contrast, pressure targeting, with its variable flow, may be easier to synchronize and will limit inspiratory pressure, but it provides no control over delivered volume. Skilled clinicians can maximize benefits and minimize problems with either flow/volume targeting or pressure targeting. Indeed, as is often the case in managing complex life-support devices, it is operator expertise rather than the device design features that most impacts patient outcomes.

摘要

在机械通气中,呼吸模式通常分为容量控制通气和压力控制通气。这两种通气模式都能有效提供肺保护性通气,但它们侧重的通气参数不同,因此对呼吸系统力学和患者努力的反应也不同。这些不同的反应行为在特定情况下各有优缺点。容量控制通气可保证设定的分钟通气量,但有时可能难以与患者努力相协调,也无法限制吸气压力。相比之下,压力控制通气采用可变的气流,可能更容易与患者努力相协调,并限制吸气压力,但无法控制输送的容量。熟练的临床医生可以最大限度地利用这两种通气模式的优势,同时将问题最小化。事实上,就像在管理复杂的生命支持设备时经常出现的情况一样,是操作人员的专业知识而非设备设计特点,对患者的预后影响最大。

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