在体外膜氧化支持期间的机械通风 - - 新趋势和持续的挑战
Konstanty Szuldrzynski1, Mariusz Kowalewski2,3,4,5, Justyna Swol6
1Department of Anaesthesiology and Intensive Care, National Institute of Medicine of the Ministry of Interior and Administration in Warsaw, Warsaw, Poland.
Perfusion
|April 23, 2024
概括
肺保护性通风对于在体外膜氧化 (ECMO) 治疗的患者至关重要. 优化呼吸器设置和理解生理相互作用是安全有效的ECMO支持严重急性呼吸困扰综合征 (ARDS) 的关键.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统生理学 呼吸系统生理学
- 支持心肺血管的支持.
背景情况:
- 机械通风对严重急性呼吸窘迫综合征 (ARDS) 患者在静脉静脉外体膜氧化 (V-V ECMO) 上的生存的影响是一个重要的研究领域.
- 最近的指南和试验越来越强调肺保护性通风策略,用于ECMO患者,无论是用于呼吸或心脏支持.
研究的目的:
- 在ECMO期间强调肺保护通风策略的重要性.
- 讨论影响V-V和V-AECMO配置中的气体交换的生理相互作用.
- 概述在ECMO期间预防诸如肺等并发症的方法.
主要方法:
- 通过减少潮体积和驱动压力来实施肺部保护性通风.
- 使用低或非常低的呼吸速率和个性化的正端呼气压力 (PEEP) 标位.
- 在ECMO期间,监测和管理设备和患者双方的血液动力学和气体交换参数.
主要成果:
- 肺部保护性通风,包括减少机械功率和量身定制的PEEP是必不可少的.
- 在V-V ECMO期间,原生肺功能至关重要;呼吸机和ECMO设置显著影响气体交换.
- ECMO参数 (例如,扫气流量,血液流量) 和患者生理学 (心脏输出,VO2,VCO2) 之间的复杂相互作用影响结果.
- 避免肺的策略包括监测左心室膨胀,优化PEEP和调整ECMO流量.
结论:
- 了解V-A ECMO期间气体交换的生理原理对于安全的临床应用至关重要.
- 需要从前性试验中获得进一步的数据,以澄清ECMO与个性化PEEP期间的作用.
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