Volume-targeted ventilation
Volume-targeted ventilation
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DOI：
10.1016/j.earlhumdev.2006.09.008
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发表时间：
2006-12-01
影响因子：
2.5
通讯作者：
Keszler, Martin
中科院分区：
文献类型：
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作者：
Keszler, Martin
认识到容量而不是压力是呼吸机诱导的肺损伤的关键因素，并且低碳酸血症和脑损伤的相关性决定了需要更好地控制输送的潮气量。容量控制通气，虽然有很大的改进，但仍然遭受由于气管内导管泄漏和回路中的气体压缩造成的容量损失。最近对压力限制、时间循环呼吸机进行的基于微处理器的修改联合收割机将压力限制通气的优势与提供更一致的潮气量的能力结合起来。每一种模式都有优点和缺点，可用于判断其有效性的数据有限。研究最彻底的容量保证模式提供峰值压力的自动脱机，以响应改善肺顺应性和呼吸努力。记录了更一致的潮气量、更少的过大呼吸、更低的峰值压力、更少的低碳酸血症和更低的炎性细胞因子水平。这些短期益处是否能转化为更短的通气时间或降低慢性肺部疾病的发生率还有待观察。(c)2006爱思唯尔爱尔兰有限公司保留所有权利。
Recognition that volume, not pressure, is the key factor in ventilator-induced lung injury and the association of hypocarbia and brain injury dictate the need to better control delivered tidal volume. Volume-controlled ventilation, though much improved, still suffers from loss of volume due to endotracheal tube leak and gas compression in the circuit. Recent microprocessor-based modifications of pressure-limited, time-cycled ventilators combine advantages of pressure-limited ventilation with the ability to deliver a more consistent tidal volume. Each of the modes has advantages and disadvantages, with limited data available to judge their effectiveness. The Volume Guarantee mode, studied most thoroughly, provides automatic weaning of peak pressure in response to improving lung compliance and respiratory effort. More consistent tidal volume, fewer excessively large breaths, lower peak pressure, less hypocarbia and lower levels of inflammatory cytokines have been documented. It remains to be seen if these short-term benefits translate into shorter duration of ventilation or reduced incidence of chronic lung disease. (c) 2006 Elsevier Ireland Ltd. All rights reserved.