Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Via Di Rudini 9, Milan, Italy.
Department of Health Sciences, University of Milan, Milan, Italy.
J Clin Monit Comput. 2022 Dec;36(6):1581-1583. doi: 10.1007/s10877-022-00885-3. Epub 2022 Jul 18.
Patients with acute brain injury have been excluded in the majority of the randomized clinical trials which evaluated a lung protective strategy in patients with acute respiratory failure. It remains unclear if low tidal volume, higher PEEP levels and recruitment maneuvers by increasing both the intracranial and intrathoracic pressure and by leading to a permissible hypercapnia could furthermore deteriorate the acute brain injury and the final outcome. Mechanical power has been associated with the outcome in ARDS patients without brain injury. Jiang et al. demonstrated in neurocritical patients that non-survivors had a higher mechanical power compared to survivors. Mechanical power was associated with an increase in intensive care mortality risk and also to an enhanced risk of hospital mortality, prolonged intensive care length of stay and fewer ventilatory free days; in addition, the mechanical power could better predict mortality compared to the Glasgow Coma Scale.
在评估急性呼吸衰竭患者肺保护性策略的大多数随机临床试验中，均排除了急性脑损伤患者。目前尚不清楚低潮气量、较高的 PEEP 水平和通过增加颅内和胸内压力以及导致允许性高碳酸血症的复张手法是否会进一步加重急性脑损伤和最终结局。机械功率与无颅脑损伤的 ARDS 患者的结局相关。Jiang 等人在神经危重症患者中证实，非存活者的机械功率高于存活者。机械功率与 ICU 死亡率风险增加以及医院死亡率、ICU 住院时间延长和通气天数减少相关；此外，机械功率与格拉斯哥昏迷量表相比，能够更好地预测死亡率。
