Abbott Megan, Li Yuchong, Brochard Laurent, Zhang Haibo
Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, ON Canada.
Department of Physiology, University of Toronto, Toronto, ON Canada.
Intensive Care Res. 2023;3(3):195-203. doi: 10.1007/s44231-023-00045-4. Epub 2023 Jul 20.
Acute respiratory distress syndrome (ARDS) has a ~ 40% mortality rate with an increasing prevalence exacerbated by the COVID-19 pandemic. Mechanical ventilation is the primary means for life-saving support to buy time for lung healing in ARDS patients, however, it can also lead to ventilator-induced lung injury (VILI). Effective strategies to reduce or prevent VILI are necessary but are not currently delivered. Therefore, we aim at evaluating the current imaging technologies to visualize where pressure and volume being delivered to the lung during mechanical ventilation; and combining plasma biomarkers to guide management of mechanical ventilation. We searched PubMed and Medline using keywords and analyzed the literature, including both animal models and human studies, to examine the independent use of computed tomography (CT) to evaluate lung mechanics, electrical impedance tomography (EIT) to guide ventilation, ultrasound to monitor lung injury, and plasma biomarkers to indicate status of lung pathophysiology. This investigation has led to our proposal of the combination of imaging and biomarkers to precisely deliver mechanical ventilation to improve patient outcomes in ARDS.
急性呼吸窘迫综合征（ARDS）的死亡率约为40%，且随着COVID-19大流行导致其患病率不断上升。机械通气是为ARDS患者争取肺部愈合时间的主要救命支持手段，然而，它也可能导致呼吸机诱导的肺损伤（VILI）。减少或预防VILI的有效策略是必要的，但目前尚未得到应用。因此，我们旨在评估当前的成像技术，以可视化机械通气期间输送到肺部的压力和容积情况；并结合血浆生物标志物来指导机械通气管理。我们使用关键词在PubMed和Medline上进行了检索并分析了文献，包括动物模型和人体研究，以研究计算机断层扫描（CT）独立用于评估肺力学、电阻抗断层扫描（EIT）用于指导通气、超声用于监测肺损伤以及血浆生物标志物用于指示肺病理生理学状态的情况。这项研究促使我们提出将成像和生物标志物相结合，以精确地进行机械通气，从而改善ARDS患者的预后。
