MacIntyre N R
Respiratory Care Services, Duke University Medical Center, Durham, North Carolina.
Clin Chest Med. 1988 Mar;9(1):47-54.
Although mechanical ventilatory support in the 1980s clearly provides adequate gas exchange with minimal side effects, there remains a need for ventilation and oxygenation in those with severe gas exchange abnormalities, for reduced airway pressure effects in those at risk for barotrauma, for a better muscle reconditioning approach in those with muscle dysfunction, and for better ventilator-patient interactions (synchrony) in many patients receiving mechanical ventilatory support. The new approaches outlined previously address these issues. However, research and development for new and better techniques are needed. Specific areas that require better understanding include the effects of intrathoracic pressure on the lungs and the circulation, the matching of ventilation and perfusion under different support modes, the function of the respiratory muscles during fatigue and recovery, and the ventilatory reflexes operational during mechanical ventilation. Only with this information can we design the optimal ventilatory support system.
尽管20世纪80年代的机械通气支持显然能以最小的副作用提供足够的气体交换，但对于存在严重气体交换异常的患者，仍需要进行通气和氧合；对于有气压伤风险的患者，需要降低气道压力的影响；对于存在肌肉功能障碍的患者，需要更好的肌肉康复方法；对于许多接受机械通气支持的患者，需要更好的呼吸机与患者的相互作用（同步性）。前面概述的新方法解决了这些问题。然而，仍需要研发新的更好的技术。需要更好理解的具体领域包括胸内压对肺和循环的影响、不同支持模式下通气与灌注的匹配、呼吸肌在疲劳和恢复过程中的功能以及机械通气期间起作用的通气反射。只有掌握这些信息，我们才能设计出最佳的通气支持系统。
