Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure
Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure
复制标题
DOI：
10.1164/rccm.201605-1081cp
复制
发表时间：
2017-02-15
影响因子：
24.7
通讯作者：
Pesenti, Antonio
中科院分区：
文献类型：
--
作者：
Brochard, Laurent;Slutsky, Arthur;Pesenti, Antonio
在急性呼吸衰竭患者中，使用机械通气来维持生命。机械通气患者的一个主要担忧是呼吸机引起的肺损伤的风险，这种损伤可以通过肺保护性通风部分预防。自主呼吸，非插管的急性呼吸衰竭患者可能有高呼吸动力，呼吸潮气量大，潜在的损害性跨肺压波动。在既有肺损伤的患者中，呼吸肌产生的区域性力量可能会在区域层面上导致损害效应。此外，吸气努力引起的跨壁肺血管压力波动的增加可能会加重血管渗漏。最近的数据表明，这些患者可能会发生与机械通气患者中观察到的呼吸机所致肺损伤相似的肺损伤。因此，我们认为，应用肺保护性通风，目前最好结合镇静和气管插管，可以被认为是一种预防性治疗，而不仅仅是支持性治疗，以最大限度地减少因患者自身造成的肺损伤而造成的肺损伤的进展。这对这些患者的管理具有重要的意义。
Mechanical ventilation is used to sustain life in patients with acute respiratory failure. A major concern in mechanically ventilated patients is the risk of ventilator-induced lung injury, which is partially prevented by lung-protective ventilation. Spontaneously breathing, nonintubated patients with acute respiratory failure may have a high respiratory drive and breathe with large tidal volumes and potentially injurious transpulmonary pressure swings. In patients with existing lung injury, regional forces generated by the respiratory muscles may lead to injurious effects on a regional level. In addition, the increase in transmural pulmonary vascular pressure swings caused by inspiratory effort may worsen vascular leakage. Recent data suggest that these patients may develop lung injury that is similar to the ventilaton-induced lung injury observed in mechanically ventilated patients. As such, we argue that application of a lung-protective ventilation, today best applied with sedation and endotracheal intubation, might be considered a prophylactic therapy, rather than just a supportive therapy, to minimize the progression of lung injury from a form of patient self-inflicted lung injury. This has important implications for the management of these patients.