驱动压导向机械通气用于治疗急性呼吸窘迫综合征的研究进展

Advances in the treatment of acute respiratory distress syndrome with driving pressure guided mechanical ventilation

急性呼吸窘迫综合征(ARDS)是常见的重症医学科(ICU)危重症,是致使ICU患者死亡的主要病因之一。过去的几十年我们对ARDS的病理生理学特点有了更深化的理解,但是现在治疗ARDS的方式仍以机械通气为主,并且各项呼吸机参数对患者生存率的影响仍不明确。现在有研究者认为相较于潮气量(VT)和呼气末正压(PEEP),驱动压(ΔP)是更能精确评估预后的重要参数。驱动压可以是一项无创且易得的评估工具,能够指导设定呼吸机相关参数、辅助肺复张,降低呼吸机相关肺损伤(VILI)的发生率,可以改善病变肺脏的不均一性及呼吸力学特点。

Acute respiratory distress syndrome(ARDS),a common critical illness in the Intensive Care Unit(ICU),is one of the leading causes of death in ICU patients.In the past few decades,we have acquired more knowledge of the pathophysiology of ARDS,but the treatment of ARDS still relies on mechanical ventilation,and the impacts of various ventilator parameters on patients'survival are still unclear.Recently,some researchers believe that driving pressure(ΔP)is an important parameter which can more accurately assess the prognosis compared with tidal volume(VT)and positive end-expiratory pressure(PEEP).As a non-invasive assessment tool easily available,ΔP can not only guide the setting of ventilator-related parameters,assist lung recruitment,as well as reduce the incidence of ventilator induced lung injury(VILI),improve the heterogeneity of diseased lung and the characteristics of respiratory mechanics.