Sessler C N
Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
Crit Care Clin. 1998 Oct;14(4):707-29, vii. doi: 10.1016/s0749-0704(05)70027-0.
Ventilatory management of patients with acute lung injury (ALI), particularly its most severe subset, acute respiratory distress syndrome (ARDS), is complex. Newer lung protective strategies emphasize measures to enhance alveolar recruitment and avoid alveolar overdistention, thus minimizing the risk of ventilator-induced lung injury (VILI). Key components of such strategies include the use of smaller-than-conventional tidal volumes which maintain peak transpulmonary pressure below the pressure associated with overdistention, and titration of positive end-expiratory pressure to promote maximal alveolar recruitment. Novel techniques, including prone positioning, inverse ratio ventilation, tracheal gas insufflation, and high frequency ventilation, are considerations in severe ARDS. No single approach is best for all patients; adjustment of ventilatory parameters to individual characteristics, such as lung mechanics and gas exchange, is required.
急性肺损伤（ALI）患者，尤其是其最严重的亚型急性呼吸窘迫综合征（ARDS）患者的通气管理很复杂。更新的肺保护策略强调采取措施增强肺泡复张并避免肺泡过度扩张，从而将呼吸机诱发的肺损伤（VILI）风险降至最低。此类策略的关键组成部分包括使用小于传统潮气量，以将跨肺压峰值维持在与过度扩张相关的压力以下，并滴定呼气末正压以促进最大程度的肺泡复张。对于严重ARDS患者，还可考虑采用俯卧位通气、反比通气、气管内吹气和高频通气等新技术。没有一种方法对所有患者都是最佳的；需要根据个体特征（如肺力学和气体交换）调整通气参数。
