Huang Hung-Yu, Huang Chih-Yu, Li Li-Fu
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
Department of Internal Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
J Clin Med. 2022 Apr 27;11(9):2451. doi: 10.3390/jcm11092451.
The number of patients requiring prolonged mechanical ventilation (PMV) is increasing worldwide, placing a burden on healthcare systems. Therefore, investigating the pathophysiology, risk factors, and treatment for PMV is crucial. Various underlying comorbidities have been associated with PMV. The pathophysiology of PMV includes the presence of an abnormal respiratory drive or ventilator-induced diaphragm dysfunction. Numerous studies have demonstrated that ventilator-induced diaphragm dysfunction is related to increases in in-hospital deaths, nosocomial pneumonia, oxidative stress, lung tissue hypoxia, ventilator dependence, and costs. Thus far, the pathophysiologic evidence for PMV has been derived from clinical human studies and experimental studies in animals. Moreover, recent studies have demonstrated the outcome benefits of pharmacological agents and rehabilitative programs for patients requiring PMV. However, methodological limitations affected these studies. Controlled prospective studies with an adequate number of participants are necessary to provide evidence of the mechanism, prognosis, and treatment of PMV. The great epidemiologic impact of PMV and the potential development of treatment make this a key research field.
全球范围内，需要长期机械通气（PMV）的患者数量不断增加，给医疗系统带来了负担。因此，研究PMV的病理生理学、危险因素及治疗方法至关重要。多种潜在合并症与PMV相关。PMV的病理生理学包括异常呼吸驱动或呼吸机诱发的膈肌功能障碍。大量研究表明，呼吸机诱发的膈肌功能障碍与住院死亡增加、医院获得性肺炎、氧化应激、肺组织缺氧、呼吸机依赖及费用增加有关。迄今为止，PMV的病理生理学证据来自临床人体研究和动物实验研究。此外，近期研究表明，药物治疗和康复计划对需要PMV的患者有益。然而，这些研究存在方法学局限性。开展有足够数量参与者的对照前瞻性研究，对于提供PMV的机制、预后及治疗证据很有必要。PMV巨大的流行病学影响以及潜在的治疗进展，使其成为一个关键的研究领域。
