Young Meilin, DiSilvio Briana, Rao Sheldon, Velliyattikuzhi Sreejith, Balaan Marvin
Division of Pulmonary-Critical Care (Drs Young, DiSilvio, Velliyattikuzhi, and Balaan) and Internal Medicine Residency, Department of Medicine (Dr Rao), Allegheny General Hospital, Allegheny Health Network, Pittsburgh.
Crit Care Nurs Q. 2019 Oct/Dec;42(4):392-399. doi: 10.1097/CNQ.0000000000000279.
Mechanical ventilation is the primary supportive, invasive measure utilized in patients with acute respiratory distress syndrome. Throughout the years, many large multicenter randomized controlled trials and observational studies were analyzed to determine what ventilator parameters to use that would produce a mortality benefit after initial diagnosis. This article discusses the concepts of ventilator-induced lung injury, permissive hypercapnia, high-versus-low peep strategies, oxygenation goals, and recruitment strategies from a physiologic perspective and the major studies that produced recommendations for each. Newer concepts, such as driving pressure, are also discussed.
机械通气是急性呼吸窘迫综合征患者采用的主要支持性侵入性措施。多年来，人们分析了许多大型多中心随机对照试验和观察性研究，以确定在初始诊断后使用哪些通气参数可带来死亡率益处。本文从生理学角度讨论了呼吸机诱导性肺损伤、允许性高碳酸血症、高呼气末正压与低呼气末正压策略、氧合目标和肺复张策略的概念，以及针对每种情况提出建议的主要研究。还讨论了诸如驱动压等较新的概念。
