Aslam Tayyba Naz, Klitgaard Thomas Lass, Hofsø Kristin, Rasmussen Bodil Steen, Laake Jon Henrik
Department of Anaesthesiology, Division of Emergencies and Critical Care, Rikshospitalet Medical Centre, Oslo University Hospital, P.O.Box 4950, Nydalen, Oslo, Norway.
Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
Curr Anesthesiol Rep. 2021;11(2):85-91. doi: 10.1007/s40140-021-00443-8. Epub 2021 Mar 3.
To review clinical evidence on whether or not to allow mechanically ventilated patients with acute respiratory distress syndrome (ARDS) to breathe spontaneously.
Observational data (LUNG SAFE study) indicate that mechanical ventilation allowing for spontaneous breathing (SB) is associated with more ventilator-free days and a shorter stay in the intensive care unit without any effect on hospital mortality. A paediatric trial, comparing airway pressure release ventilation (APRV) and low-tidal volume ventilation, showed an increase in mortality in the APRV group. Conversely, in an unpublished trial comparing SB and controlled ventilation (NCT01862016), the authors concluded that SB is feasible but did not improve outcomes in ARDS patients.
A paucity of clinical trial data continues to prevent firm guidance on if or when to allow SB during mechanical ventilation in patients with ARDS. No published large randomised controlled trial exists to inform practice about the benefits and harms of either mode.
回顾关于是否允许急性呼吸窘迫综合征（ARDS）机械通气患者自主呼吸的临床证据。
观察性数据（LUNG SAFE研究）表明，允许自主呼吸（SB）的机械通气与更多无呼吸机天数及在重症监护病房的住院时间缩短相关，且对医院死亡率无影响。一项比较气道压力释放通气（APRV）和低潮气量通气的儿科试验显示，APRV组死亡率增加。相反，在一项比较SB和控制通气的未发表试验（NCT01862016）中，作者得出结论，SB是可行的，但并未改善ARDS患者的预后。
临床试验数据匮乏，仍无法就ARDS患者机械通气期间是否允许或何时允许SB提供明确指导。尚无已发表的大型随机对照试验为两种模式的利弊提供实践依据。
