Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medicine, Georg-August-University Göttingen, Göttingen, Germany.
Curr Opin Crit Care. 2012 Feb;18(1):61-9. doi: 10.1097/MCC.0b013e32834f3e8a.
New developments in mechanical ventilation have focused on increasing the patient's control of the ventilator by implementing information on lung mechanics and respiratory drive. Effort-adapted modes of assisted breathing are presented and their potential advantages are discussed.
Adaptive support ventilation, proportional assist ventilation with load adjustable gain factors and neurally adjusted ventilatory assist are ventilatory modes that follow the concept of adapting the assist to a defined target, instantaneous changes in respiratory drive or lung mechanics. Improved patient ventilator interaction, sufficient unloading of the respiratory muscles and increased comfort have been recently associated with these ventilator modalities. There are, however, scarce data with regard to outcome improvement, such as length of mechanical ventilation, ICU stay or mortality (commonly accepted targets to demonstrate clinical superiority).
Within recent years, a major step forward in the evolution of assisted (effort-adapted) modes of mechanical ventilation was accomplished. There is growing evidence that supports the physiological concept of closed-loop effort-adapted assisted modes of mechanical ventilation. However, at present, the translation into a clear outcome benefit remains to be proven. In order to fill the knowledge gap that impedes the broader application, larger randomized controlled trials are urgently needed. However, with clearly proven drawbacks of conventional assisted modes such as pressure support ventilation, it is probably about time to leave these modes introduced decades ago behind.
机械通气的新进展集中于通过实施有关肺力学和呼吸驱动的信息来增加患者对呼吸机的控制。本文介绍了适应努力的辅助呼吸模式及其潜在优势。
适应性支持通气、具有可调节增益因子的比例辅助通气和神经调节通气辅助是根据适应辅助到定义目标、呼吸驱动或肺力学的瞬时变化的概念设计的通气模式。最近，这些通气模式与改善患者-呼吸机相互作用、充分减轻呼吸肌负荷和提高舒适度相关。然而，关于改善预后（如机械通气时间、ICU 住院时间或死亡率）的数据很少（通常用于证明临床优越性的目标）。
近年来，辅助通气（适应努力）模式的发展取得了重大进展。越来越多的证据支持闭环努力适应辅助通气模式的生理概念。然而，目前，转化为明确的临床获益仍有待证明。为了填补阻碍广泛应用的知识空白，迫切需要进行更大规模的随机对照试验。然而，由于传统辅助通气模式（如压力支持通气）明显存在缺点，可能是时候将这些几十年前引入的模式抛在脑后了。
