Improved mechanical ventilation requires more than just increased ventilator availability: A word of caution
Improved mechanical ventilation requires more than just increased ventilator availability: A word of caution
复制标题
改善机械通气需要的不仅仅是增加呼吸机的可用性：警告
DOI：
10.1002/ctm2.43
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发表时间：
2020-06
影响因子：
10.6
通讯作者：
Zhou Luqian
中科院分区：
文献类型：
--
作者：
Guan Lili;Li Shiyue;Le Grange Jehane Michael;Yang Yuqiong;Chen Rongchang;Zhou Luqian
2019年12月，中国发现了一批病因不明的肺炎病例，后来证实是由严重急性呼吸系统综合征冠状病毒2型引起的，随后被命名为2019冠状病毒病（COVID-19）。到目前为止，绝大多数患者为轻度病例，约20%的患者被归类为重度或危重病。重度或危重COVID-19患者可能会出现低氧血症性呼吸衰竭，需要呼吸支持来改善缺氧或缓解呼吸困难。机械呼吸机是治疗重症或危重COVID 19患者最重要的医疗设备之一。根据美国医院协会的估计，美国约有960 000名病人需要机械通气，而先前的一项研究估计，美国急症护理医院只有62 188台功能全面的机械通气机和98 738台功能有限的机械通气机。目前，全球对卫生保健设施中的制冷剂的需求不断增长。随着疫情期间呼吸机供应减少，制造商正共同努力增加产能，以满足这些临床需求。然而，仅仅增加制冷机的数量是不够的，还有其他问题需要解决。不仅需要机械通气的患者数量不断增加，而且呼吸治疗师或训练有素的肺部和重症监护人员也缺乏，熟练操作机械通气机。此外，其他部门的医务人员、退休医务人员甚至医学生都参与治疗重症或危重COVID-19患者。在正常情况下，呼吸机操作人员接受多年的培训，以便正确使用呼吸机并优化通气参数。科隆博等人研究了意大利重症监护室（ICU）医生使用呼吸机波形检测患者-呼吸机故障的能力。建议有经验的临床医生（在
A cluster of pneumonia cases with an unknown etiology were identified in China in December 2019, and later confirmed to be caused by the severe acute respiratory syndrome coronavirus-2 and subsequently named coronavirus disease 2019 (COVID-19). So far, the vast majority of patients are presented as mild cases, with approximately 20% of patients categorized with severe or critical illness. Patients with severe or critical COVID-19 may develop hypoxemic respiratory failure and require respiratory support to improve hypoxia or relieve dyspnea. Mechanical ventilators are among the most significant medical devices in the treatment of severe or critical COVID19 patients. About 960 000 patients in the United States will need mechanical ventilation, according to an estimation by the American Hospital Association, while a previous study estimated that there were only 62 188 mechanical ventilators with comprehensive functionalities and 98 738 mechanical ventilators with limited functionalities in the United States acute care hospitals. Currently, there is a growing global demand for ventilators in health care facilities. With the reduced availability of ventilators during the pandemic, manufacturers are working together to increase capacity and meet these clinical demands. However, simply increasing the number of ventilators is not enough, and there are other issues that need to be addressed. Not only is the number of patients requiring mechanical ventilation increasing, but there is also a shortage of respiratory therapists or well-trained pulmonary and critical care staff, skilled in the operation of mechanical ventilators. Additionally, medical staff from other departments, retired medical staff, or even medical students are involved in treating patients with severe or critical COVID-19. Under normal circumstances, ventilator operators receive years of training in order to use the ventilator correctly and optimize ventilation parameters. Colombo et al investigated the ability of Italian intensive care unit (ICU) physicians to detect patient-ventilator asynchrony using ventilator waveforms. It was suggested that experienced clinicians (working in the
影响因子：
158.5
作者：
Li, Qun;Guan, Xuhua;Feng, Zijian
通讯作者：
Feng, Zijian
影响因子：
2.7
作者：
Rubinson, Lewis;Vaughn, Frances;Branson, Richard
通讯作者：
Branson, Richard
影响因子：
8.8
作者：
Colombo, Davide;Cammarota, Gianmaria;Navalesi, Paolo
通讯作者：
Navalesi, Paolo