机械通气临床应用指南（2006）

Practical guidelines for mechanical ventilation （2006）

器官功能支持是重症医学临床实践的重要内容之一。机械通气开始仅作为肺脏通气功能支持治疗手段，目前已发展到涉及气体交换、呼吸做功、肺损伤、胸腔内器官压力及容积环境、循环功能等多方面的重要干预措施，并主要通过提高氧输送（DO2）、保护肺脏、改善内环境等途径，成为治疗多器官功能障碍综合征（MODS）的重要手段。不同疾病对机械通气具有特异性的要求，医学理论的发展及循证医学数据的增加对呼吸机临床应用提出了更加明确的针对性和规范性。中华医学会重症医学分会以循证医学证据为基础，采用国际通用方法．广泛征求意见和建议，反复认真讨论，达成关于机械通气临床应用方面的共识，以期对危重患者的机械通气临床应用进行规范。中华医学会重症医学分会今后还将根据循证医学证据的发展及新的共识对《机械通气临床应用指南》进行更新。指南中的推荐意见依据2001年ISF提出的Delphi分级标准，所涉及的文献按照研究方法和结果分成5个层次．推荐意见的推荐级别按照Delphi分级分为A～E级，其中A级为最高。

With the expanding understanding of basic knowledge concerning respiratory function and technology of respirator, mechanical ventilation has become an important interventional armamentarium to improve gas exchange and decrease respiratory work. It is one of the important means to enhance oxygen delivery, protect the lung, and restore homeostasis in the treatment of multiple organ dysfunction syndrome. The progression in medical sciences and increasing data pertaining to evidence - based medicine have also render the use of mechanical ventilation standardized with more appropriate indication. Under the aforementioned conditions, it seems to be essential that the indications and the operation and manipulation of the sophisticated ventilator should be standardized in the care of critically ill patients. At the same time, accumulation of clinical experiences in recent years with abundant relevant data as a result of multi - center studies have furnished highly valuable information to accomplish this effort. Based on evidenced - base data, the Chinese Society of Critical Care Medicine （Chinese Medical Association） held a consensus conference to draft a guideline for the recommendation of mechanical ventilation to categorize all the information gathered from the literature into five grades from A to E, with A being the highest, according to a modified Delphi criteria, which were adopted by the International Sepsis Forum held in 2001. After further nationwide inquiries and conscientious discussions, this guideline has been drafted pending further addition and correction. This guideline chiefly covers the following aspects： the choice of mechanical ventilation for critically ill patients, the aim and indication of mechanical ventilation, non -invasive positive pressure ventilation, regulation of modes and settings of the ventilator, etc. With implementation of the guideline, it is hoped that the clinical use of mechanical ventilation in the critically ill patients will be more or less standardized. The guideline will be updated when new knowledge is available.