Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Keenan Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
Semin Respir Crit Care Med. 2019 Feb;40(1):66-80. doi: 10.1055/s-0039-1685159. Epub 2019 May 6.
The high prevalence of acute respiratory distress syndrome (ARDS), its morbidity and mortality continue to fare a huge burden in the intensive care unit. More than 40 years ago, experimental studies have highlighted that, albeit essential, mechanical ventilation could be harmful to lungs and more recently to the diaphragm. Despite life-saving advances in mechanical ventilation (such as low tidal-volume ventilation, neuromuscular blockers agents, or prone positioning), a recent international observational study reported that most ARDS patients were not appropriately monitored. The monitoring capabilities of ventilators, in particular the simple interaction of the patient and the mechanical ventilation, are very powerful but are underutilized. This lack of monitoring may contribute to the persisting poor outcome of patients with ARDS. Providing a more careful ventilation is a priority to improve patients' outcomes. To achieve this goal, it is of paramount importance to better understand the complex relationship between the patient and the ventilator: the impact of ventilator settings on lungs during passive controlled ventilation, but also of patient's breathing efforts on lungs during assisted ventilation. In this review we present available tools to monitor respiratory mechanics at the bedside aiming at optimizing and personalizing mechanical ventilation. Hopefully, this careful management can decrease mortality of patients with ARDS in the future.
急性呼吸窘迫综合征（ARDS）的高患病率及其发病率和死亡率继续给重症监护病房带来巨大负担。四十多年前，实验研究就已经强调，尽管机械通气是必要的，但它可能对肺部，甚至对横膈膜造成损害。尽管机械通气在救生方面取得了进步（例如低潮气量通气、神经肌肉阻滞剂或俯卧位），但最近一项国际观察性研究报告称，大多数 ARDS 患者并未得到适当监测。呼吸机的监测能力，尤其是患者与机械通气的简单相互作用，非常强大，但未得到充分利用。这种监测不足可能导致 ARDS 患者的预后仍然较差。提供更谨慎的通气是改善患者预后的首要任务。为了实现这一目标，至关重要的是要更好地了解患者与呼吸机之间的复杂关系：在被动控制通气期间，呼吸机设置对肺部的影响，以及在辅助通气期间，患者呼吸努力对肺部的影响。在这篇综述中，我们介绍了可在床边监测呼吸力学的工具，旨在优化和个性化机械通气。希望这种谨慎的管理能够降低未来 ARDS 患者的死亡率。
