1 Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
2 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Am J Respir Crit Care Med. 2017 Oct 1;196(7):822-833. doi: 10.1164/rccm.201612-2495CI.
Acute respiratory distress syndrome is a multifactorial lung injury that continues to be associated with high levels of morbidity and mortality. Mechanical ventilation, although lifesaving, is associated with new iatrogenic injury. Current best practice involves the use of small Vt, low plateau and driving pressures, and high levels of positive end-expiratory pressure. Collectively, these interventions are termed "lung-protective ventilation." Recent investigations suggest that individualized measurements of pulmonary mechanical variables rather than population-based ventilation prescriptions may be used to set the ventilator with the potential to improve outcomes beyond those achieved with standard lung protective ventilation. This review outlines the measurement and application of clinically applicable pulmonary mechanical concepts, such as plateau pressures, driving pressure, transpulmonary pressures, stress index, and measurement of strain. In addition, the concept of the "baby lung" and the utility of dynamic in addition to static measures of pulmonary mechanical variables are discussed.
急性呼吸窘迫综合征是一种多因素肺损伤，其发病率和死亡率仍然很高。机械通气虽然可以救命，但也会导致新的医源性损伤。目前的最佳实践包括使用小潮气量、低平台压和驱动压以及高水平的呼气末正压。这些干预措施统称为“肺保护性通气”。最近的研究表明，与基于人群的通气处方相比，对肺力学变量进行个体化测量可能用于设置呼吸机，从而有可能改善标准肺保护性通气所取得的结果。这篇综述概述了临床应用的肺力学概念的测量和应用，如平台压、驱动压、跨肺压、压力指数以及应变的测量。此外，还讨论了“婴儿肺”的概念以及动态和静态肺力学变量测量的应用。
