Stanford University - School of Medicine Department of Anesthesiology, Perioperative and Pain Medicine, 300 Pasteur Drive, Room H3580, Stanford, CA 94305, USA.
Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
Anesthesiol Clin. 2023 Mar;41(1):121-140. doi: 10.1016/j.anclin.2022.11.004.
Strategies for the intraoperative ventilator management of the critically ill patient focus on parameters used for lung protective ventilation with acute respiratory distress syndrome, preventing or limiting the deleterious effects of mechanical ventilation, and optimizing anesthetic and surgical conditions to limit postoperative pulmonary complications for patients at risk. Patient conditions such as obesity, sepsis, the need for laparoscopic surgery, or one-lung ventilation may benefit from intraoperative lung protective ventilation strategies. Anesthesiologists can use risk evaluation and prediction tools, monitor advanced physiologic targets, and incorporate new innovative monitoring techniques to develop an individualized approach for patients.
危重症患者术中呼吸机管理策略侧重于急性呼吸窘迫综合征患者的肺保护性通气参数,预防或限制机械通气的有害影响,并优化麻醉和手术条件,以降低高危患者术后肺部并发症的风险。肥胖、脓毒症、需要腹腔镜手术或单肺通气等患者情况可能受益于术中肺保护性通气策略。麻醉师可以使用风险评估和预测工具,监测高级生理目标,并结合新的创新监测技术,为患者制定个体化方案。