Narrative review: ventilator-induced respiratory muscle weakness.
Narrative review: ventilator-induced respiratory muscle weakness.
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DOI：
10.7326/0003-4819-153-4-201008170-00006
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发表时间：
2010-08-17
影响因子：
39.2
通讯作者：
Jubran A
中科院分区：
文献类型：
--
作者：
Tobin MJ;Laghi F;Jubran A
临床医生早就意识到，当机械通气对肺实质施加太大压力时会导致严重的肺损伤。越来越多的证据表明，当呼吸机对呼吸肌施加的压力太小时，也可能导致严重的损伤。通过调整呼吸机设置和给予药物治疗，可以使呼吸肌几乎（或完全）不活动。对动物的研究表明，肌肉不活动会导致肌肉纤维严重损伤和萎缩。最近的人类数据显示，与机械通气相关的18至69小时的完全小脑不活动使小脑纤维的横截面积减少一半或更多。萎缩性损伤似乎是由于氧化应激增加导致蛋白质降解途径活化所致。对呼吸机引起的呼吸肌损伤的科学认识尚未达到可以进行有意义的对照试验的阶段，因此不可能为患者管理提供具体建议。与此同时，建议临床医生选择呼吸机设置，以避免过度的患者努力和过度的呼吸肌休息。呼吸机屏幕上气道压力波形的轮廓提供了患者努力的最实际指示，建议临床医生在滴定呼吸机设置时密切关注波形。呼吸机引起的呼吸肌损伤的研究还处于起步阶段，预示着这将是一个令人兴奋的研究领域。
Clinicians have long been aware that substantial lung injury results when mechanical ventilation imposes too much stress on the pulmonary parenchyma. Evidence is accruing that substantial injury may also result when the ventilator imposes too little stress on the respiratory muscles. Through adjustment of ventilator settings and administration of pharmacotherapy it is possible to render the respiratory muscles almost (or completely) inactive. Research in animals has shown that diaphragmatic inactivity produces severe injury and atrophy of muscle fibers. Human data have recently revealed that 18 to 69 hours of complete diaphragmatic inactivity associated with mechanical ventilation decreased the cross-sectional areas of diaphragmatic fibers by half or more. The atrophic injury appears to result from increased oxidative stress leading to activation of protein-degradation pathways. Scientific understanding of ventilator-induced respiratory muscle injury has not reached the stage where it is possible to undertake meaningful controlled trials and thus it is not possible to render concrete recommendations for patient management. In the meantime, clinicians are advised to select ventilator settings that avoid both excessive patient effort and also excessive respiratory muscle rest. The contour of the airway pressure waveform on a ventilator screen provides the most practical indication of patient effort, and clinicians are advised to pay close attention to the waveform as they titrate ventilator settings. Research on ventilator-induced respiratory muscle injury is in its infancy and portends to be an exciting area to follow.
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影响因子：
158.5
作者：
SEGREDO, V;CALDWELL, JE;MILLER, RD
通讯作者：
MILLER, RD
DOI：
10.1164/rccm.200601-142oc
发表时间：
2007-01-15
影响因子：
24.7
作者：
McClung, Joseph M.;Kavazis, Andreas N.;Powers, Scott K.
通讯作者：
Powers, Scott K.
DOI：
10.1164/rccm.200401-042oc
发表时间：
2004-09-15
影响因子：
24.7
作者：
Sassoon, CSH;Zhu, EC;Caiozzo, VJ
通讯作者：
Caiozzo, VJ
影响因子：
5.1
作者：
KNISELY, AS;LEAL, SM;SINGER, DB
通讯作者：
SINGER, DB
影响因子：
3.3
作者：
Laghi, F;Topeli, A;Tobin, MJ
通讯作者：
Tobin, MJ