The concept of "baby lung"
The concept of "baby lung"
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DOI：
10.1007/s00134-005-2627-z
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发表时间：
2005-06-01
影响因子：
38.9
通讯作者：
Pesenti, A
中科院分区：
文献类型：
--
作者：
Gattinoni, L;Pesenti, A
背景：“婴儿肺”的概念起源于计算机断层扫描检查，该检查显示大多数急性肺损伤/急性呼吸窘迫综合征患者的正常通气组织具有 5 至 6 岁儿童肺的尺寸（300 - 500 克通气组织）。讨论：呼吸系统顺应性与“婴儿肺”尺寸线性相关，表明急性呼吸窘迫综合征的肺不是“僵硬”而是很小，具有接近正常的内在弹性。最初，我们教导“婴儿肺”是一种独特的解剖结构，位于非依赖性肺区域。然而，俯卧位的密度重新分布表明“婴儿肺”是一个功能性概念，而不是一个解剖学概念。这为“温和的肺部治疗”提供了理论依据，并为解释气压伤和容积伤等概念提供了背景。结论：从生理角度来看，“婴儿肺”有助于理解呼吸机引起的肺损伤。在这种情况下，看起来危险的不是 VT/kg 比率，而是 VT/“婴儿肺”比率。实际信息很简单：“婴儿肺”越小，不安全机械通气的可能性就越大。
Background: The "baby lung" concept originated as an offspring of computed tomography examinations which showed in most patients with acute lung injury/ acute respiratory distress syndrome that the normally aerated tissue has the dimensions of the lung of a 5- to 6-year- old child ( 300 - 500 g aerated tissue). Discussion: The respiratory system compliance is linearly related to the " baby lung" dimensions, suggesting that the acute respiratory distress syndrome lung is not " stiff" but instead small, with nearly normal intrinsic elasticity. Initially we taught that the " baby lung" is a distinct anatomical structure, in the nondependent lung regions. However, the density redistribution in prone position shows that the " baby lung" is a functional and not an anatomical concept. This provides a rational for "gentle lung treatment" and a background to explain concepts such as baro- and volutrauma. Conclusions: From a physiological perspective the "baby lung" helps to understand ventilator-induced lung injury. In this context, what appears dangerous is not the VT/kg ratio but instead the VT/" baby lung" ratio. The practical message is straightforward: the smaller the "baby lung," the greater is the potential for unsafe mechanical ventilation.