Singh Sarvesh Pal, Hote Milind Padmakar
Department of Cardio-Thoracic and Vascular Surgery, Cardio-Thoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, 110029 India.
Indian J Thorac Cardiovasc Surg. 2021 Apr;37(Suppl 2):248-253. doi: 10.1007/s12055-020-01021-z. Epub 2020 Aug 12.
Extracorporeal membrane oxygenation (ECMO) is the final treatment offered to patients of acute respiratory distress syndrome (ARDS). The survival (to discharge) of patients on veno-venous ECMO is approximately 59% with an average duration of 8 days. The ventilatory management of lungs during the ECMO may have an impact on mortality. An ideal ventilation modality should promote recovery, prevent further damage to the alveoli, and enable weaning from mechanical ventilation. This article reviews the concept of "baby lung" in ARDS and the current evidence for the use of lung protective ventilation, prevention of ventilator-induced lung injury, recommended modes of mechanical ventilation, ideal ventilatory parameters (tidal volume, positive end expiratory pressure, plateau pressure, respiratory rate, fractional inspired oxygen concentration), and use of adjuncts (prone positioning, neuromuscular blocking agents) during the ECMO course.
体外膜肺氧合（ECMO）是为急性呼吸窘迫综合征（ARDS）患者提供的最终治疗手段。接受静脉 - 静脉ECMO治疗的患者出院生存率约为59%，平均治疗时长为8天。ECMO期间肺部的通气管理可能会对死亡率产生影响。理想的通气方式应促进恢复、防止肺泡进一步受损，并实现机械通气撤机。本文综述了ARDS中“婴儿肺”的概念以及目前关于肺保护性通气、预防呼吸机诱导性肺损伤、推荐的机械通气模式、理想通气参数（潮气量、呼气末正压、平台压、呼吸频率、吸入氧分数）以及ECMO治疗过程中辅助手段（俯卧位、神经肌肉阻滞剂）使用的证据。
