胸部手术期间的手术内机械通风:当代争议和不断发展的策略
Jakob Wittenstein1, Federico Piccioni2, Caroline M Vanpeteghem3
1Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.
Current opinion in anaesthesiology
|November 12, 2025
概括
个性化机械通风,特别是正极呼气压 (PEEP) 定位,在胸部手术中有望减少术后肺部并发症. 需要进一步的研究来验证治疗捆绑和新兴概念,如化学动力.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 胸部外科手术 胸部外科手术
背景情况:
- 术内机械通风策略对于进行胸部手术的患者的管理至关重要.
- 优化通风的目的是防止术后肺部并发症 (PPC).
- 目前关于最有效的通风参数和方法的证据正在不断发展.
研究的目的:
- 审查和综合最近关于胸部手术期间手术内机械通风的证据.
- 专注于围绕正极呼气压 (PEEP),机械/化学功率,驱动压力和治疗捆绑的争议.
- 确定外科手术期间通风的趋势和未来研究方向.
主要方法:
- 最近随机对照试验和元分析的系统审查和综合.
- 对固定与个性化PEEP,高与低PEEP,驱动压力和机械/化学功率的证据分析.
- 评估治疗包的整合和影响.
主要成果:
- 与固定PEEP相比,个性化PEEP定位似乎可以减少PPC.
- 高PEEP可能会增加血液动力学风险;低PEEP可能会增加血动力学风险.
- 驱动压力和机械功率是公认的PPC预测因素,个性化策略显示了好处.
- 疗法捆绑显示出希望,但需要进一步验证.
结论:
- 胸部外科手术中明显的趋势是个性化外科通风策略,特别是PEEP定位.
- 治疗捆绑和个性化术后护理,包括高流量鼻氧,是减少PPCs的新兴补充.
- 需要进行大规模试验,以确认这些策略的临床价值,并澄清化学力量和治疗捆绑的作用.
相关概念视频
Mechanical Ventilation II: Invasive Ventilation
604
Ventilators are essential medical equipment used to aid patients with respiratory difficulties. Their primary function is to assist or replace spontaneous breathing by providing mechanical ventilation. There are two general classes of mechanical ventilators: negative-pressure and positive-pressure ventilators.
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
604
Mechanical Ventilation III: Noninvasive Ventilation
489
Noninvasive positive-pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) are essential methods in respiratory care. These ventilation techniques offer unique benefits for patients with various respiratory conditions, providing adequate support without requiring intubation. Let's explore how each method is crucial in improving patient outcomes and enhancing respiratory therapy.
Noninvasive Positive-Pressure Ventilation...
Noninvasive Positive-Pressure Ventilation...
489
Mechanical Ventilation I: Indication and Settings
2.5K
Mechanical ventilation is a life-saving technique for managing acute respiratory failure and other respiratory complications. The process involves using a machine known as a ventilator to supply oxygen to the lungs and assist in removing carbon dioxide. It serves as a bridge to long-term mechanical ventilation or a temporary measure until ventilatory support is discontinued. The ventilator can maintain this function for a prolonged period, providing critical support for patients until they can...
2.5K
Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
448
Airway management is essential in emergency and surgical medicine, ensuring ventilation and oxygenation in patients who cannot maintain their own airway. Clinicians use a range of techniques and devices to secure the airway, depending on the patient’s condition and the clinical context. Key methods include endotracheal intubation, rapid sequence intubation (RSI), supraglottic airway devices, and advanced visualization aids. In cases where these approaches fail, surgical airway...
448
Cardiopulmonary Resuscitation II: ACLS Airway Management
506
Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
506
Ventilatory Modes
1.3K
Mechanical ventilators are life-saving devices that support or replace spontaneous breathing. They deliver breaths to patients through varying methods known as ventilator modes. Understanding these modes is critical for healthcare providers managing patients with respiratory failure.
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...
1.3K


