正确认识急性呼吸窘迫综合征患者的自主呼吸

Correct understanding of spontaneous breathing in patients with acute respiratory distress syndrome

急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是临床常见危重症,病死率较高,肺保护性机械通气仍然是ARDS患者治疗的基石,对于ARDS患者,保留自主呼吸是一把“双刃剑”,ARDS患者在机械通气过程中保持耐受良好的自主呼吸努力可以为患者带来益处,过强的自主呼吸努力则会加重肺损伤。临床医生应该在对患者呼吸驱动有效的评估下,允许患者对自主呼吸努力耐受良好的情况下保留适当自主呼吸努力,使患者从自主呼吸获益,同时避免机械通气相关性肺损伤和患者自身造成的肺损伤。

Acute respiratory distress syndrome(ARDS)is a common clinical critical illness with a high mortality rate. Lung protective mechanical ventilation is still the cornerstone of the treatment. Spontaneous breathing is a "double-edged sword" for patients with ARDS. The effort of maintaining a well-tolerated spontaneous breathing during mechanical ventilation can bring benefits to the patient with ARDS,while excessive spontaneous breathing effort may aggravate lung injury. Clinicians should allow patients to retain appropriate spontaneous breathing efforts under an effective assessment of the breathing drive,so that patients might benefit from spontaneous breathing and at the same time avoid mechanical ventilation-related lung injury and patient self-inflicted lung injury.