aPulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany bDepartment of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
Curr Opin Crit Care. 2014 Feb;20(1):69-76. doi: 10.1097/MCC.0000000000000055.
This review summarizes the most recent clinical and experimental data on the impact of spontaneous breathing in acute respiratory distress syndrome (ARDS).
Spontaneous breathing during assisted as well as nonassisted modes of mechanical ventilation improves lung function and reduces lung damage in mild and moderate ARDS. New modes of assisted mechanical ventilation with improved patient ventilator interaction and enhanced variability of the respiratory pattern offer additional benefit on lung function and damage. However, data supporting an outcome benefit of spontaneous breathing in ARDS, even in its mild and moderate forms, are missing. In contrast, controlled mechanical ventilation with muscle paralysis in the first 48 h of severe ARDS has been shown to improve survival, as compared with placebo. Currently, it is unclear whether ventilator settings, rather than the severity of lung injury, determine the potential of spontaneous breathing for benefit or harm.
Clinical and experimental studies show that controlled mechanical ventilation with muscle paralysis in the early phase of severe ARDS reduces lung injury and even mortality. At present, spontaneous breathing should be avoided in the early phase of severe ARDS, but considered in mild-to-moderate ARDS.
本文总结了急性呼吸窘迫综合征（ARDS）中自发性呼吸对临床和实验数据的最新影响。
辅助通气和非辅助通气模式下的自发性呼吸可改善轻度和中度 ARDS 的肺功能并减轻肺损伤。辅助机械通气的新模式改善了患者与呼吸机的相互作用，并增强了呼吸模式的可变性，从而为肺功能和损伤提供了额外的益处。但是，缺乏支持 ARDS 中自发性呼吸获益的数据，即使是轻度和中度 ARDS。相比之下，在严重 ARDS 的前 48 小时内使用肌肉麻痹进行控制性机械通气已被证明可提高存活率，而安慰剂组则没有。目前尚不清楚是呼吸机设置，而不是肺损伤的严重程度，决定了自发性呼吸的获益或危害潜力。
临床和实验研究表明，在严重 ARDS 的早期阶段使用肌肉麻痹的控制性机械通气可减轻肺损伤甚至降低死亡率。目前，严重 ARDS 的早期阶段应避免自发性呼吸，但可考虑在轻度至中度 ARDS 中使用。
