Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
Neonatology. 2011;99(4):338-41. doi: 10.1159/000326843. Epub 2011 Jun 23.
Ventilator-induced lung injury (VILI) is considered an important risk factor in the development of bronchopulmonary dysplasia (BPD) and is primarily caused by overdistension (volutrauma) and repetitive opening and collapse (atelectrauma) of terminal lung units. Lung-protective ventilation should therefore aim to reduce tidal volumes, and recruit and stabilize atelectatic lung units (open lung ventilation strategy). This review will summarize the available evidence on lung-protective ventilation in neonatology, discussing both high-frequency ventilation (HFV) and positive pressure ventilation (PPV). It shows that HFV does not appear to have a clear benefit over PPV, although most studies failed to apply a true open lung ventilation strategy during HFV. The evidence on the optimal tidal volume, positive end-expiratory pressure and the role for lung recruitment during lung-protective PPV is extremely limited. Volume-targeted ventilation seems to be a promising mode in terms of lung protection, but more studies are needed. Due to the lack of convincing evidence, lung-protective ventilation and modes seem to be implemented in daily clinical practice at a slow pace.
呼吸机相关性肺损伤（VILI）被认为是支气管肺发育不良（BPD）发展的一个重要危险因素，主要由过度膨胀（容积伤）和终末肺单位的反复开放和塌陷（萎陷伤）引起。因此，肺保护性通气应旨在减少潮气量，并募集和稳定肺不张单位（开放肺通气策略）。这篇综述将总结新生儿肺保护性通气的现有证据，讨论高频通气（HFV）和正压通气（PPV）。结果表明，HFV 似乎并没有明显优于 PPV 的优势，尽管大多数研究在 HFV 期间未能真正应用开放肺通气策略。关于肺保护性 PPV 中最佳潮气量、呼气末正压和肺复张作用的证据极其有限。容量目标通气在肺保护方面似乎是一种很有前途的模式，但还需要更多的研究。由于缺乏令人信服的证据，肺保护性通气和模式在临床实践中的应用速度似乎较慢。
