Department of Anesthesiology and Intensive Care Therapy, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
Curr Opin Anaesthesiol. 2012 Apr;25(2):148-55. doi: 10.1097/ACO.0b013e3283504bde.
We aimed at providing the most recent and relevant evidence regarding spontaneous breathing activity during mechanical ventilation in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Both clinical and experimental data are depicted.
The use of unsupported spontaneous breathing has been associated with the most beneficial effects reported to date, but recent data favors also pressure-supported breathing activity in experimental ALI. In patients with ALI/ARDS, unsupported spontaneous breathing in combination with mandatory cycles has been shown to improve lung function, reduce the need for sedation and cardiocirculatory drug therapy, and speed weaning, with no effect on mortality. On the other hand, strong clinical evidence shows that the use of neuromuscular blocking agents in the first 48 h of mechanical ventilation with the volume assist-control ventilation mode reduces morbidity and mortality in severe ARDS compared to placebo.
In our opinion, spontaneous breathing activity should be avoided in the first 48 h of mechanical ventilation in patients with severe ARDS (PaO2/FIO2 <120 mmHg), but it may be useful in less severe ARDS and ALI. Clearly, further clinical and experimental investigations on the use of different ventilation modes of supported/unsupported spontaneous breathing in ALI/ARDS are needed.
本文旨在提供有关急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）机械通气期间自主呼吸活动的最新且最相关的证据。本文描述了临床和实验数据。
目前，与支持自主呼吸相关的研究结果最有益，但最近的数据也支持在实验性 ALI 中应用压力支持自主呼吸活动。在 ALI/ARDS 患者中，与强制通气相结合的不支持自主呼吸已被证明可以改善肺功能，减少镇静和心血管药物治疗的需求，并加速撤机，而对死亡率没有影响。另一方面，强有力的临床证据表明，与安慰剂相比，在机械通气的最初 48 小时内使用容量辅助控制通气模式和神经肌肉阻滞剂可降低严重 ARDS 的发病率和死亡率。
在我们看来，严重 ARDS（PaO2/FIO2<120mmHg）患者机械通气的最初 48 小时内应避免自主呼吸活动，但在不太严重的 ARDS 和 ALI 中可能有用。显然，需要进一步进行关于不同通气模式的支持/不支持自主呼吸在 ALI/ARDS 中的应用的临床和实验研究。
