School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, Italy.
Semin Respir Crit Care Med. 2022 Jun;43(3):346-368. doi: 10.1055/s-0042-1748917. Epub 2022 Jul 27.
Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure burden by high hospital mortality. No specific pharmacologic treatment is currently available and its ventilatory management is a key strategy to allow reparative and regenerative lung tissue processes. Unfortunately, a poor management of mechanical ventilation can induce ventilation induced lung injury (VILI) caused by physical and biological forces which are at play. Different parameters have been described over the years to assess lung injury severity and facilitate optimization of mechanical ventilation. Indices of lung injury severity include variables related to gas exchange abnormalities, ventilatory setting and respiratory mechanics, ventilation intensity, and the presence of lung hyperinflation versus derecruitment. Recently, specific indexes have been proposed to quantify the stress and the strain released over time using more comprehensive algorithms of calculation such as the mechanical power, and the interaction between driving pressure (DP) and respiratory rate (RR) in the novel DP multiplied by four plus RR [(4 × DP) + RR] index. These new parameters introduce the concept of ventilation intensity as contributing factor of VILI. Ventilation intensity should be taken into account to optimize protective mechanical ventilation strategies, with the aim to reduce intensity to the lowest level required to maintain gas exchange to reduce the potential for VILI. This is further gaining relevance in the current era of phenotyping and enrichment strategies in ARDS.
急性呼吸窘迫综合征（ARDS）是一种严重的呼吸衰竭形式，其住院死亡率较高。目前尚无特定的药物治疗方法，其通气管理是允许修复和再生肺组织过程的关键策略。不幸的是，机械通气管理不当会导致通气引起的肺损伤（VILI），这是由发挥作用的物理和生物学力引起的。多年来，已经描述了不同的参数来评估肺损伤的严重程度，并促进机械通气的优化。肺损伤严重程度的指标包括与气体交换异常、通气设置和呼吸力学、通气强度以及肺过度充气与去复张有关的变量。最近，已经提出了一些特定的指标，以便使用更全面的计算算法（如机械功率）来量化随着时间的推移释放的压力和应变，并使用驱动压（DP）与呼吸频率（RR）的乘积的新型 DP 乘以 4 加 RR[（4×DP）+RR]指数来量化。这些新参数引入了通气强度作为 VILI 致病因素的概念。应考虑通气强度以优化保护性机械通气策略，目的是将强度降低到维持气体交换所需的最低水平，以降低发生 VILI 的可能性。在 ARDS 的表型和富集策略的当前时代，这一点变得更加重要。
