肺保护策略机械通气的再评价

通常认为急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者应用肺保护策略机械通气可降低病死率,主要由于潮气量的降低。对已发表的随机对照研究再次分析,发现平台压与患者病死率明显相关。平台压低于30cmH2O时,潮气量可以在一定范围内增加,不影响患者预后。但选择小潮气量可能对病人有害。随机对照研究在试验设计、统计学分析、病人同质性等方面依然存在很多问题。从现有资料看,潮气量和平台压都很重要。

Re-evaluation of Lung-Protective Mechanical Ventilation

The use of a volume-and pressure-limited mechanical ventilation strategy improves clinical outcomes of patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS). We reviewed the results of five randomized clinical trials of lung-protective mechanical ventilation strategies. Found mortality and Pplat are relative. We could adjust tide volume when inspiratory plateau pressures less than 30 cm H2O, We could not identify a safe upper limit for plateau pressures in patients with ALI/ARDS. There are some problems in RCT itself. Tide volume and plateau pressures are both important.