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机械呼吸患者的自发呼吸引起的肺损伤
Taiki Hoshino1, Takeshi Yoshida
1Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Current opinion in critical care
|November 11, 2024
概括
在机械通风过程中自发呼吸可能会损害肺部. 诸如神经肌肉阻塞,PEEP和倾斜定位等策略可以预防ARDS患者的肺损伤.
科学领域:
- 关键护理医学 关键护理医学
- 肺部医学 肺部医学
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 新出现的证据表明,自发的呼吸努力可能会导致肺损伤.
- 在急性呼吸窘迫综合征 (ARDS) 中,机械通风可能因患者的努力而复杂化.
- 了解自发呼吸诱导的肺损伤 (SBILI) 对患者的治疗结果至关重要.
研究的目的:
- 在ARDS中审查机械通风期间自发呼吸的有害影响.
- 识别和讨论减少自发呼吸引起的肺损伤的策略.
主要方法:
- 最近实验和临床研究的文献综述.
- 关于SBILI机制的发现综合.
- 分析拟议和实施的管理策略.
主要成果:
- 强烈的自发呼吸可以通过高跨肺压力,Pendelluft,增加 perfusion 和异步导致肺损伤.
- 神经肌肉阻断剂是有效的,但携带诸如肌肉缩等风险.
- 替代策略包括部分,神经阻塞,镇静剂,更高的PEEP和倾斜的定位.
结论:
- 几种策略可以减轻自发呼吸诱导的肺损伤.
- 神经肌肉阻塞,部分,神经阻塞,镇静剂,PEEP和倾斜定位是潜在的干预措施.
- 与保持隔膜功能平衡肺部保护是关键.
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