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在重症儿科喘中进行侵入性呼吸系统支持
Christopher J L Newth1,2, Patrick A Ross2,3
1Dr. Newth is affiliated with Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.
Respiratory care
|March 3, 2025
概括
机械通风对于严重的喘是最后的手段. 策略的重点是避免肺损伤和血液动力学不稳定性,仔细注意通风设置,避免快速血气校正.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 儿科呼吸系统医学 儿科呼吸系统医学
背景情况:
- 由于非侵入性疗法,需要机械通风的严重喘减少了.
- 机械通风在其他治疗方法失败时,是一种拯救生命的干预措施.
- 预先规划输管和通风是非常重要的.
研究的目的:
- 在严重喘中概述机械通风的最佳实践.
- 突出潜在的并发症和减轻它们的策略.
- 讨论替代疗法和救援疗法.
主要方法:
- 对当前用于严重喘的机械通风策略的审查.
- 讨论通风器参数优化 (例如,平原压力,PEEP).
- 评估辅助疗法,如Heliox,吸入麻醉剂和ECMO.
主要成果:
- 升高的分钟通风可以导致高通胀和血液动力学不稳定.
- 理想情况下,平原压力应保持在25-30厘米H2O以下.
- 建议使用低通风率和PEEP,而不需要快速血气校正.
- 体外膜氧化 (ECMO) 对空气泄漏综合征有效.
结论:
- 对严重喘的机械通风需要谨慎管理,以防止并发症.
- 辅助疗法和ECMO等救助选择可能至关重要.
- 虽然大多数机械通风儿童存活下来,但与喘相关的长期死亡率令人担忧.
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