Wang Chieh-Jen, Wang I-Ting, Chen Chao-Hsien, Tang Yen-Hsiang, Lin Hsin-Wei, Lin Chang-Yi, Wu Chien-Liang
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104217, Taiwan.
Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan.
J Pers Med. 2024 Jul 23;14(8):779. doi: 10.3390/jpm14080779.
Even though much progress has been made to improve clinical outcomes, acute respiratory distress syndrome (ARDS) remains a significant cause of acute respiratory failure. Protective mechanical ventilation is the backbone of supportive care for these patients; however, there are still many unresolved issues in its setting. The primary goal of mechanical ventilation is to improve oxygenation and ventilation. The use of positive pressure, especially positive end-expiratory pressure (PEEP), is mandatory in this approach. However, PEEP is a double-edged sword. How to safely set positive end-inspiratory pressure has long been elusive to clinicians. We hereby propose a pressure-volume curve measurement-based method to assess whether injured lungs are recruitable in order to set an appropriate PEEP. For the most severe form of ARDS, extracorporeal membrane oxygenation (ECMO) is considered as the salvage therapy. However, the high level of medical resources required and associated complications make its use in patients with severe ARDS controversial. Our proposed protocol also attempts to propose how to improve patient outcomes by balancing the possible overuse of resources with minimizing patient harm due to dangerous ventilator settings. A recruitment-potential-oriented evaluation-based protocol can effectively stabilize hypoxemic conditions quickly and screen out truly serious patients.
尽管在改善临床结局方面已取得很大进展，但急性呼吸窘迫综合征（ARDS）仍然是急性呼吸衰竭的重要原因。保护性机械通气是这些患者支持治疗的核心；然而，在其设置方面仍有许多未解决的问题。机械通气的主要目标是改善氧合和通气。在这种方法中，使用正压，尤其是呼气末正压（PEEP）是必不可少的。然而，PEEP是一把双刃剑。长期以来，临床医生一直难以确定如何安全地设置吸气末正压。我们在此提出一种基于压力-容积曲线测量的方法，以评估受损肺是否可复张，从而设置合适的PEEP。对于最严重形式的ARDS，体外膜肺氧合（ECMO）被视为挽救治疗方法。然而，所需的高医疗资源水平和相关并发症使得其在重症ARDS患者中的应用存在争议。我们提出的方案还试图提出如何通过平衡可能的资源过度使用与将危险通气设置对患者的伤害降至最低来改善患者结局。基于复张潜力评估的方案可以有效地快速稳定低氧状况，并筛选出真正严重的患者。
