在儿科外体生命支持过程中机械通风
Martin C J Kneyber1,2, Ira M Cheifetz3
1Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen.
Current opinion in pediatrics
|July 27, 2023
概括
呼吸机诱导的肺损伤 (VILI) 和患者自身造成的肺损伤是儿童体外膜氧化 (ECMO) 的关键问题. 优化机械通风策略对于这些患者的肺部恢复至关重要.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 呼吸系统生理学 呼吸系统生理学
- 身体之外的生命支持.
背景情况:
- 体外膜氧化 (ECMO) 对于耐火性心肺衰竭至关重要.
- 在ECMO治疗的儿科ARDS患者中,最佳的机械通风 (MV) 仍在争论中.
- 证据经常从非ECMO ARDS和成年人群中推断出来.
研究的目的:
- 在儿科ECMO中审查呼吸器诱导的肺损伤 (VILI) 和患者自我造成的肺损伤的作用.
- 在ECMO上讨论当前的理解和儿童呼吸器管理的未来方向.
主要方法:
- 文献审查和现有证据的综合.
- 从非ECMO和成人数据中抽出ARDS患者的发现.
- 讨论当前的最佳实践和未来研究领域.
主要成果:
- 儿科ECMO中的机械通风应限制吸气和驱动压力.
- 建议适当的正极呼气压 (PEEP) 和低呼吸速率来减少机械功率.
- 对自发呼吸和辅助治疗的个性化方法是必要的.
结论:
- 需要进一步的研究来确定儿科ECMO的最佳MV策略.
- 降低机械通风强度是减少VILI和促进肺部恢复的关键.
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