Dynamic alveolar mechanics and ventilator-induced lung injury.
Dynamic alveolar mechanics and ventilator-induced lung injury.
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DOI：
10.1097/01.ccm.0000155928.95341.bc
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发表时间：
2005-03-01
影响因子：
8.8
通讯作者：
Nieman, Gary
中科院分区：
文献类型：
--
作者：
Carney, David;DiRocco, Joseph;Nieman, Gary
目的：回顾动态肺泡力学的机制（即，观察正常肺和急性肺损伤肺泡大小和形态的动态变化，探讨急性肺损伤后肺泡力学的改变作为呼吸机诱导肺损伤（VILI）的机制;并检验与机械通气保护策略相关的发病率和死亡率降低与肺泡力学正常化相关的假设。综合：这篇综述是基于原始发表的文章和综述文章，涉及肺泡水平肺体积变化的机制和肺泡力学改变作为VILI机制的作用。此外，从我们的实验室直接可视化动态肺泡力学的数据进行了审查和相关的literature.CONCLUSIONS：肺泡充气在正常肺的机制尚不清楚。尽管如此，正常的肺泡是非常稳定的，并且随着通气而改变的大小非常小。急性肺损伤引起个体肺泡的显著不稳定。肺泡不稳定导致肺损伤，被认为是VILI机制的主要组成部分。降低肺泡不稳定性的呼吸机策略可能会降低VILI相关的发病率和死亡率。
OBJECTIVES: To review the mechanism of dynamic alveolar mechanics (i.e., the dynamic change in alveolar size and shape during ventilation) in both the normal and acutely injured lung; to investigate the alteration in alveolar mechanics secondary to acute lung injury as a mechanism of ventilator-induced lung injury (VILI); and to examine the hypothesis that the reduced morbidity and mortality associated with protective strategies of mechanical ventilation is related to the normalization of alveolar mechanics.DATA EXTRACTION AND SYNTHESIS: This review is based on original published articles and review papers dealing with the mechanism of lung volume change at the alveolar level and the role of altered alveolar mechanics as a mechanism of VILI. In addition, data from our laboratory directly visualizing dynamic alveolar mechanics is reviewed and related to the literature.CONCLUSIONS: The mechanism of alveolar inflation in normal lungs is unclear. Nonetheless, normal alveoli are very stable and change size very little with ventilation. Acute lung injury causes marked destabilization of individual alveoli. Alveolar instability causes pulmonary damage and is believed to be a major component in the mechanism of VILI. Ventilator strategies that reduce alveolar instability may potentially reduce the morbidity and mortality associated with VILI.