Ventilator-induced lung injury
Ventilator-induced lung injury
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DOI：
10.1183/09031936.03.00420103
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发表时间：
2003-08-01
影响因子：
24.3
通讯作者：
Saumon, G
中科院分区：
文献类型：
--
作者：
Ricard, JD;Dreyfuss, D;Saumon, G
在机械通气期间，高吸气末肺容量（无论是由于大潮气量（V-T）和/或高水平的呼气末正压）导致渗透性肺水肿，称为呼吸机诱导的肺损伤（VILI）。既往损伤使肺对机械通气敏感。在V-T降低的急性呼吸窘迫综合征患者中观察到死亡率降低22%后，这一实验概念最近得到了响亮的临床说明。此外，有人认为，在低肺容量时重复打开和关闭远端单位可能会诱发肺损伤，但在低潮气量和呼气末容积升高以减轻肺损伤的急性呼吸窘迫综合征临床网络评估结果为阴性后，这一观点在概念上和临床上都受到了挑战实验和临床上，VILI中炎性细胞因子的参与尚未明确证实。细胞对机械拉伸的反应已经越来越多地被研究，在上皮和内皮侧。脂质膜运输被认为是细胞对压力衰竭作出反应的一种手段，呼吸机引起的肺损伤期间呼吸系统压力/容积曲线的改变包括顺应性降低和上拐点位置的改变是由于气道远端阻塞减少了通气肺容积。来自该曲线的信息可以帮助避免潜在有害的过度潮气量减少。
During mechanical ventilation, high end-inspiratory lung volume (whether it be because of large tidal volume (V-T) and/or high levels of positive end-expiratory pressure) results in a permeability type pulmonary oedema, called ventilator-induced lung injury (VILI). Previous injury sensitises lung to mechanical ventilation..This experimental concept has recently received a resounding clinical illustration after a 22% reduction of mortality was observed in acute respiratory distress syndrome patients whose V-T had been reduced. In addition, it has been suggested that repetitive opening and closing of distal units at low lung volume could induce lung injury but this notion has been challenged both conceptually and clinically after the negative results of the Acute Respiratory Distress Syndrome clinical Network Assessment of Low tidal Volume and Elevated end-expiratory volume to Obviate Lung Injury (ARDSNet ALVEOLI) study.Experimentally and clinically, involvement of inflammatory cytokines in VILI has not been unequivocally demonstrated. Cellular response to mechanical stretch has been increasingly investigated, both on the epithelial and the endothelial side. Lipid membrane trafficking has been thought to be a means by which cells respond to stress failure.Alterations in the respiratory system pressure/volume curve during ventilator-induced lung injury that include decrease in compliance and position of the upper inflection point are due to distal obstruction of airways that reduce aerated lung volume. Information from this curve could help avoid potentially harmful excessive tidal volume reduction.