Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, Illinois, USA.
Compr Physiol. 2012 Oct;2(4):2871-921. doi: 10.1002/cphy.c110030.
The development of acute ventilatory failure represents an inability of the respiratory control system to maintain a level of respiratory motor output to cope with the metabolic demands of the body. The level of respiratory motor output is also the main determinant of the degree of respiratory distress experienced by such patients. As ventilatory failure progresses and patient distress increases, mechanical ventilation is instituted to help the respiratory muscles cope with the heightened workload. While a patient is connected to a ventilator, a physician's ability to align the rhythm of the machine with the rhythm of the patient's respiratory centers becomes the primary determinant of the level of rest accorded to the respiratory muscles. Problems of alignment are manifested as failure to trigger, double triggering, an inflationary gas-flow that fails to match inspiratory demands, and an inflation phase that persists after a patient's respiratory centers have switched to expiration. With recovery from disorders that precipitated the initial bout of acute ventilatory failure, attempts are made to discontinue the ventilator (weaning). About 20% of weaning attempts fail, ultimately, because the respiratory controller is unable to sustain ventilation and this failure is signaled by development of rapid shallow breathing. Substantial advances in the medical management of acute ventilatory failure that requires ventilator assistance are most likely to result from research yielding novel insights into the operation of the respiratory control system.
急性通气衰竭的发展代表着呼吸系统无法维持一定水平的呼吸输出，以满足身体的代谢需求。呼吸输出的水平也是此类患者呼吸困难程度的主要决定因素。随着通气衰竭的进展和患者痛苦的增加，会采用机械通气来帮助呼吸肌应对增加的工作量。当患者与呼吸机连接时，医生调整机器节律与患者呼吸中枢节律一致的能力成为呼吸肌得到休息程度的主要决定因素。不匹配的表现为无法触发、双重触发、充气气流与吸气需求不匹配，以及在患者呼吸中枢切换到呼气后充气阶段持续存在。随着引发初始急性通气衰竭发作的疾病的恢复，会尝试停止呼吸机（脱机）。大约 20%的脱机尝试最终失败，因为呼吸控制器无法维持通气，这一失败的信号是出现快速浅呼吸。对需要呼吸机辅助的急性通气衰竭的医疗管理的重大进展很可能源于对呼吸控制系统运作的新见解的研究。
