优化通风功率以避免VILI
Lauren T Thornton1, John J Marini2
1Department of Pulmonary and Critical Care Medicine, University of Minnesota, Minneapolis/St Paul, MN, USA.
Journal of intensive care
|November 21, 2023
概括
尽量减少呼吸器引起的肺损伤 (VILI) 涉及多方面的策略. 关键的方法包括允许性高头,减少氧气需求,容易定位,并调整呼吸机设置以保护肺部,同时保持气体交换.
科学领域:
- 关键护理医学 关键护理医学
- 肺部医学 肺部医学
- 机械通风机械通风机械通风
背景情况:
- 呼吸机引起的肺损伤 (VILI) 是重症监护中的一个重大风险.
- 通风期间的危险功率是VILI的一个关键决定因素.
- 肺部保护策略旨在减轻VILI,同时确保充分的气体交换.
研究的目的:
- 概述一个多方面的方法,以尽量减少VILI风险.
- 为了确定可修改的呼吸机相关的肺部保护的决定因素.
- 突出影响VILI的被低估的辅助因素.
主要方法:
- 通过允许性高头和减少氧气需求,减少了对适当通风的需求.
- 利用倾斜的身体定位来改善气体交换和应力分布.
- 修改通风器设置:潮体积,平原压力,驱动压力,PEEP,吸气流和通风频率.
- 考虑较低的血管压力和血流作为条件辅助因子.
主要成果:
- 策略的组合有效调节通风功率.
- 这些措施旨在避免VILI.
- 可以达到临床上可接受的肺气交换目标.
结论:
- 尽量减少VILI需要一个全面的,多方面的方法.
- 呼吸机的设置和患者的位置是可以修改的关键因素.
- 整合各种策略可以优化肺部保护和气体交换结果.
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