Robotham J L, Scharf S M
Clin Chest Med. 1983 May;4(2):161-87.
We have critically reviewed our present understanding of the complex hemodynamic events occurring during spontaneous and mechanical ventilation. It is clear that the physiologic events occurring during normal conditions are present but may be relatively less important under pathophysiologic conditions. Furthermore, since spontaneous ventilation and mechanical ventilation are not simply opposites, evaluation of one ventilatory mode aids in understanding the hemodynamic events in the other. While we have not discussed the hemodynamic events during high frequency oscillation, only with a full understanding of both spontaneous respiration and conventional IPPV can the full implications of this new mode of ventilation be appreciated. It seems a reasonable assumption that in the critically ill patient with cardiopulmonary dysfunction, one mode of ventilation will be optimal and another either less so or even detrimental. Only with an understanding of the hemodynamic effects of respiration can the optimal therapeutic modality be tailored to each patient.
我们严格审视了目前对自主通气和机械通气过程中发生的复杂血流动力学事件的理解。显然，正常情况下发生的生理事件依然存在，但在病理生理条件下可能相对没那么重要。此外，由于自主通气和机械通气并非简单的相反情况，对一种通气模式的评估有助于理解另一种通气模式中的血流动力学事件。虽然我们尚未讨论高频振荡期间的血流动力学事件，但只有充分理解自主呼吸和传统间歇正压通气，才能领会这种新通气模式的全部意义。似乎有一个合理的假设，即在患有心肺功能障碍的重症患者中，一种通气模式将是最佳的，而另一种要么效果稍差，要么甚至有害。只有了解呼吸对血流动力学的影响，才能为每个患者量身定制最佳治疗方式。
