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急性呼吸窘迫综合征机械通气中的肺和膈肌保护。

Lung and Diaphragm Protection During Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome.

机构信息

Critical Care Department, Hospital del Mar de Barcelona, Critical Illness Research Group (GREPAC), Hospital del Mar Research Institute (IMIM), Passeig Marítim de la Barceloneta 25-29, Ciutat Vella, 08003, Barcelona, Spain; Interdepartmental Division of Critical Care Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada; Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada.

Interdepartmental Division of Critical Care Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada; Division of Respirology, Department of Medicine, University Health Network, Toronto, Canada; University Health Network/Sinai Health System, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada; Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Department of Physiology, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada.

出版信息

Clin Chest Med. 2024 Dec;45(4):863-875. doi: 10.1016/j.ccm.2024.08.007. Epub 2024 Sep 20.

Abstract

Patients with acute respiratory distress syndrome often require mechanical ventilation to maintain adequate gas exchange and to reduce the workload of the respiratory muscles. Although lifesaving, positive pressure mechanical ventilation can potentially injure the lungs and diaphragm, further worsening patient outcomes. While the effect of mechanical ventilation on the risk of developing lung injury is widely appreciated, its potentially deleterious effects on the diaphragm have only recently come to be considered by the broader intensive care unit community. Importantly, both ventilator-induced lung injury and ventilator-induced diaphragm dysfunction are associated with worse patient-centered outcomes.

摘要

急性呼吸窘迫综合征患者常需要机械通气来维持充足的气体交换和降低呼吸肌的负荷。尽管机械通气是救命的,但正压通气可能会损伤肺和膈肌,进一步恶化患者的预后。虽然机械通气对肺损伤风险的影响已被广泛认识,但通气引起的膈肌功能障碍最近才引起更广泛的重症监护病房的关注。重要的是,呼吸机相关性肺损伤和呼吸机相关性膈肌功能障碍均与更差的以患者为中心的结局相关。

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