Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation.
Korean J Anesthesiol. 2020 Jun;73(3):179-193. doi: 10.4097/kja.19499. Epub 2020 Jan 31.
The prevention of ventilator-associated lung injury (VALI) and postoperative pulmonary complications (PPC) is of paramount importance for improving outcomes both in the operating room and in the intensive care unit (ICU). Protective respiratory support includes a wide spectrum of interventions to decrease pulmonary stress-strain injuries. The motto 'low tidal volume for all' should become routine, both during major surgery and in the ICU, while application of a high positive end-expiratory pressure (PEEP) strategy and of alveolar recruitment maneuvers requires a personalized approach and requires further investigation. Patient self-inflicted lung injury is an important type of VALI, which should be diagnosed and mitigated at the early stage, during restoration of spontaneous breathing. This narrative review highlights the strategies used for protective positive pressure ventilation. The emerging concepts of damaging energy and power, as well as pathways to personalization of the respiratory settings, are discussed in detail. In the future, individualized approaches to protective ventilation may involve multiple respiratory settings extending beyond low tidal volume and PEEP, implemented in parallel with quantifying the risk of VALI and PPC.
预防呼吸机相关性肺损伤（VALI）和术后肺部并发症（PPC）对于改善手术室和重症监护病房（ICU）的预后至关重要。保护性呼吸支持包括一系列降低肺应激-应变损伤的干预措施。“所有患者均采用低潮气量”的原则应成为常规，无论是在大手术期间还是在 ICU 中，而应用高呼气末正压（PEEP）策略和肺泡复张手法需要个体化方法，并需要进一步研究。患者自伤性肺损伤是一种重要的 VALI 类型，应在自主呼吸恢复期间早期诊断和减轻。本综述强调了用于保护性正压通气的策略。详细讨论了破坏性能量和功率的新概念，以及呼吸设置个体化的途径。未来，保护性通气的个体化方法可能涉及多种呼吸设置，不仅限于低潮气量和 PEEP，同时还需要量化 VALI 和 PPC 的风险。
