临床实践指南:机械通风和体外膜氧化在急性呼吸系统衰竭中
Deutsches Arzteblatt international
|January 6, 2026
概括
这份更新的指导方针建议避免使用非侵入性支持进行输管,并在侵入性通风过程中早期实现自发呼吸. 对于中度至严重的急性呼吸困扰综合征 (ARDS),更高的PEEP降低了死亡率,而不建议进行常规的肌肉松或皮质类固醇.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统医学 呼吸系统医学
- 机械通风机械通风机械通风
背景情况:
- 侵入性通风可以挽救生命,但会带来诸如肺损伤和功能障碍等风险.
- 最近的数据需要对机械通风的临床治疗途径进行审查.
- 基于证据的重新评估对于优化患者的治疗结果至关重要.
研究的目的:
- 为机械通风提供最新的临床实践指南.
- 纳入最新的证据来管理急性呼吸衰竭和ARDS.
- 引导临床医生优化呼吸机设置和辅助疗法.
主要方法:
- 在Medline,Embase和Cochrane图书馆进行系统的文献搜索,直到2023年4月,补充到2024年6月.
- 使用基于GRADE方法的证据决策框架 (EtDF) 制定建议.
- 包括重症监护护士和早期职业生涯临床医生科学家的投入.
主要成果:
- 建议使用非侵入性呼吸支,以避免在急性呼吸衰竭中输管.
- 建议在侵入性通风过程中提前启动自发呼吸.
- 对于中度至重度的ARDS,建议采用更高的阳性末端呼气压 (PEEP) 定位策略,显示出9%的绝对死亡率降低.
- 对于中度至重度的ARDS,强烈建议不要进行常规的肌肉松或使用皮质类固醇.
- 在经验丰富的中心,静脉静脉外体膜氧化 (VV-ECMO) 被认为是严重的ARDS与持续的气体交换障碍.
结论:
- 呼吸器治疗的目标包括早期自发呼吸,保护性呼吸参数和个性化的PEEP.
- 肌肉松或皮质类固醇的常规使用不支持中度至重度ARDS管理.
- 优化PEEP和促进早期从机械通风中释放是改善患者结果的关键.
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