Department of Anesthesiology and Intensive Care, University Hospital Ostrava, Ostrava, Czech Republic.
Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science,VSB - Technical University of Ostrava, Ostrava, Czech Republic.
Med Sci Monit. 2023 Sep 5;29:e941287. doi: 10.12659/MSM.941287.
Mechanical ventilation (MV) provides basic organ support for patients who have acute hypoxemic respiratory failure, with acute respiratory distress syndrome as the most severe form. The use of excessive ventilation forces can exacerbate the lung condition and lead to ventilator-induced lung injury (VILI); mechanical energy (ME) or power can characterize such forces applied during MV. The ME metric combines all MV parameters affecting the respiratory system (ie, lungs, chest, and airways) into a single value. Besides evaluating the overall ME, this parameter can be also related to patient-specific characteristics, such as lung compliance or patient weight, which can further improve the value of ME for characterizing the aggressiveness of lung ventilation. High ME is associated with poor outcomes and could be used as a prognostic parameter and indicator of the risk of VILI. ME is rarely determined in everyday practice because the calculations are complicated and based on multiple equations. Although low ME does not conclusively prevent the possibility of VILI (eg, due to the lung inhomogeneity and preexisting damage), individualization of MV settings considering ME appears to improve outcomes. This article aims to review the roles of bedside assessment of mechanical power, its relevance in mechanical ventilation, and its associations with treatment outcomes. In addition, we discuss methods for ME determination, aiming to propose the most suitable method for bedside application of the ME concept in everyday practice.
机械通气（MV）为急性低氧性呼吸衰竭患者提供基本的器官支持，以急性呼吸窘迫综合征为最严重形式。过度通气力的使用会加重肺部状况并导致呼吸机相关性肺损伤（VILI）；机械能（ME）或功率可以描述 MV 期间施加的此类力。ME 指标将影响呼吸系统（即肺、胸部和气道）的所有 MV 参数组合成一个单一值。除了评估整体 ME 外，该参数还可以与患者特定特征相关，例如肺顺应性或患者体重，这可以进一步提高 ME 用于描述肺通气侵袭性的价值。高 ME 与不良结局相关，可作为预后参数和 VILI 风险的指标。由于计算复杂且基于多个方程，因此 ME 很少在日常实践中确定。尽管低 ME 并不能完全排除发生 VILI 的可能性（例如，由于肺部不均匀性和预先存在的损伤），但根据 ME 考虑 MV 设置的个体化似乎可以改善结局。本文旨在综述床边机械功率评估的作用、其在机械通气中的相关性以及与治疗结局的关系。此外，我们还讨论了 ME 确定的方法，旨在提出最适合床边应用 ME 概念的方法，以在日常实践中应用。
