流体管理策略及其与机械通风的相互作用:从实验研究到临床实践
Eduardo Butturini de Carvalho1,2, Denise Battaglini3, Chiara Robba3,4
1Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Intensive care medicine experimental
|July 20, 2023
概括
了解流体管理和机械通风对于患者的治疗结果至关重要. 本综述探讨了流体策略如何与通风相互作用以影响肺部和器官损伤,帮助临床决策.
科学领域:
- 关键护理医学 关键护理医学
- 肺部医学 肺部医学
- 重症监护病房管理部门的管理.
背景情况:
- 机械通风患者通过限制性或自由的策略接受静脉注射液体.
- 在限制性和自由流体管理之间缺乏明确的区分.
- 这两种策略都有风险:限制性可能会导致低输液,自由性可能会导致内皮损伤和器官功能障碍.
研究的目的:
- 阐明流体管理和机械通风策略之间的相互作用.
- 了解这些相互作用如何影响肺部和远端器官损伤.
- 为管理重病患者的临床医生提供更好的理解.
主要方法:
- 现有文献的叙述性审查.
- 专注于静脉注射液体和机械通风参数之间的相互作用.
- 不包括断奶和消活阶段.
主要成果:
- 自由流体管理可能会增强呼吸器诱导的肺损伤 (VILI),特别是压力支通风.
- 在自由流体管理下,高或突然变化的正极呼气压 (PEEP) 会增加肺内皮细胞损伤.
- 将这些相互作用与临床结果联系在一起的翻译证据仍然很少.
结论:
- 特定的流体和通风策略的组合可以加剧肺部和器官的损伤.
- 需要进一步的研究来将实验发现转化为临床实践.
- 优化流体和通风策略对于最大限度地减少机械通风患者的阳性损伤至关重要.
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