Emerging concepts in ventilation-induced lung injury.
Emerging concepts in ventilation-induced lung injury.
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DOI：
10.12688/f1000research.20576.1
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发表时间：
2020-01-01
期刊：
影响因子：
--
通讯作者：
Beitler, Jeremy R
中科院分区：
文献类型：
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作者：
Madahar, Purnema;Beitler, Jeremy R
通气引起的肺损伤是由易感肺潮气通气期间发生的机械应力和应变引起的。对通气引起的肺损伤的经典描述集中于正压通气造成的危害。然而，患者的努力和患者与呼吸机的相互作用也可能产生有害的力量。虽然整体力学的作用早已被认识到，但肺内的局部力学异质性似乎也是传播临床显着肺损伤的重要因素。由此产生的临床表型包括肺损伤恶化和导致肺外器官衰竭的全身炎症反应。鉴于通气引起的肺损伤表现不明确且缺乏明确的诊断，床旁识别需要高度的临床敏锐度。然而，通气引起的肺损伤的临床重要性是显而易见的。预防此类生物物理损伤仍然是降低急性呼吸窘迫综合征患者发病率和死亡率的最有效管理策略，并可能使其他面临风险的人受益。
Ventilation-induced lung injury results from mechanical stress and strain that occur during tidal ventilation in the susceptible lung. Classical descriptions of ventilation-induced lung injury have focused on harm from positive pressure ventilation. However, injurious forces also can be generated by patient effort and patient-ventilator interactions. While the role of global mechanics has long been recognized, regional mechanical heterogeneity within the lungs also appears to be an important factor propagating clinically significant lung injury. The resulting clinical phenotype includes worsening lung injury and a systemic inflammatory response that drives extrapulmonary organ failures. Bedside recognition of ventilation-induced lung injury requires a high degree of clinical acuity given its indistinct presentation and lack of definitive diagnostics. Yet the clinical importance of ventilation-induced lung injury is clear. Preventing such biophysical injury remains the most effective management strategy to decrease morbidity and mortality in patients with acute respiratory distress syndrome and likely benefits others at risk.