Pediatric Acute Respiratory Distress Syndrome: Increase the Positive End-Expiratory Pressure?
Pediatric Acute Respiratory Distress Syndrome: Increase the Positive End-Expiratory Pressure?
复制标题
小儿急性呼吸窘迫综合征：增加呼气末正压？
DOI：
10.1164/rccm.201802-0266ed
复制
发表时间：
2018
影响因子：
24.7
通讯作者：
Ware,LorraineB
中科院分区：
文献类型：
--
作者：
McKown,AndrewC;Ware,LorraineB
The goals of mechanical ventilation in acute respiratory distress syndrome (ARDS) are to maintain adequate oxygenation and ventilation while simultaneously avoiding injurious stress and strain. Standard maneuvers to improve arterial oxygen saturation are delivery of higher FIO2 and increasing positive end-expiratory pressure (PEEP) to improve ventilation and perfusion matching and recruit collapsed alveoli. PEEP has the added benefit of potentially reducing ventilator-induced lung injury by diminishing atelectrauma and minimizing exposure to potentially toxic high FIO2, if balanced appropriately with the risk for alveolar overdistension (1, 2). Substantial research has been performed on PEEP optimization, but the current standard of care for adults with ARDS derives from the ARDS Network (ARDSNet) trials employing a fixed titration table of FIO2 and PEEP that was generated by expert consensus (3, 4). Three large trials examined higher versus lower PEEP (4–6), and although no individual trial showed a difference in outcomes, a meta-analysis suggested that in moderate-severe ARDS, higher PEEP was associated with improved survival (7). A recent trial of alveolar recruitment and higher PEEP for ARDS, however, showed an increased mortality in the intervention arm that runs counter to the trend of improved survival with higher PEEP (8).
