Muldiiarov Vladislav, Buesing Keely L
Department of Surgery, Division of Acute Care Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Crit Care Res Pract. 2025 Jul 26;2025:8857930. doi: 10.1155/ccrp/8857930. eCollection 2025.
Mechanical ventilation is indispensable for the management of acute respiratory distress syndrome (ARDS), yet suboptimal ventilator settings can exacerbate lung injury. There is growing evidence that lung-protective ventilation strategies reduce ventilator-induced lung injury (VILI) and improve outcomes. Understanding the role of key parameters, such as driving pressure and tidal volume, is essential for optimizing patient care. This narrative review synthesizes the evidence underpinning the evolution of lung-protective ventilation strategies in ARDS, focusing on the importance of low tidal volume ventilation and the monitoring of driving pressure. A targeted literature search was performed in PubMed, Embase, The Cochrane Library, Google Scholar, and Web of Science up to April 2025, focusing on adult ARDS. Original research studies (randomized controlled trials, retrospective and prospective cohort studies) and meta-analyses published in English were included. Evidence supports adopting lung-protective strategies, including low tidal volume ventilation and careful driving pressure monitoring, to reduce VILI and improve survival in ARDS patients. By integrating these evidence-based principles into mechanical ventilation management, clinicians can enhance patient outcomes, reduce iatrogenic harm, and advance the overall quality of ARDS care.
机械通气对于急性呼吸窘迫综合征（ARDS）的治疗不可或缺，但呼吸机设置欠佳会加重肺损伤。越来越多的证据表明，肺保护性通气策略可减少呼吸机诱导的肺损伤（VILI）并改善预后。了解驱动压力和潮气量等关键参数的作用对于优化患者护理至关重要。本叙述性综述综合了支持ARDS中肺保护性通气策略演变的证据，重点关注低潮气量通气的重要性和驱动压力监测。截至2025年4月，在PubMed、Embase、Cochrane图书馆、谷歌学术和科学网进行了有针对性的文献检索，重点关注成人ARDS。纳入了以英文发表的原始研究（随机对照试验、回顾性和前瞻性队列研究）和荟萃分析。有证据支持采用肺保护性策略，包括低潮气量通气和仔细监测驱动压力，以减少VILI并提高ARDS患者的生存率。通过将这些循证原则纳入机械通气管理，临床医生可以改善患者预后，减少医源性伤害，并提高ARDS护理的整体质量。
