The Impact of Mechanical Energy Assessment on Mechanical Ventilation: A Comprehensive Review and Practical Application.

Filip Burša, David Oczka, Ondřej Jor, Peter Sklienka, Michal Frelich, Jan Stigler, Vojtech Vodička, Tereza Ekrtová, Marek Penhaker, Jan Máca
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引用次数: 1

Abstract

Mechanical ventilation (MV) provides basic organ support for patients who have acute hypoxemic respiratory failure, with acute respiratory distress syndrome as the most severe form. The use of excessive ventilation forces can exacerbate the lung condition and lead to ventilator-induced lung injury (VILI); mechanical energy (ME) or power can characterize such forces applied during MV. The ME metric combines all MV parameters affecting the respiratory system (ie, lungs, chest, and airways) into a single value. Besides evaluating the overall ME, this parameter can be also related to patient-specific characteristics, such as lung compliance or patient weight, which can further improve the value of ME for characterizing the aggressiveness of lung ventilation. High ME is associated with poor outcomes and could be used as a prognostic parameter and indicator of the risk of VILI. ME is rarely determined in everyday practice because the calculations are complicated and based on multiple equations. Although low ME does not conclusively prevent the possibility of VILI (eg, due to the lung inhomogeneity and preexisting damage), individualization of MV settings considering ME appears to improve outcomes. This article aims to review the roles of bedside assessment of mechanical power, its relevance in mechanical ventilation, and its associations with treatment outcomes. In addition, we discuss methods for ME determination, aiming to propose the most suitable method for bedside application of the ME concept in everyday practice.

Abstract Image

机械能评价对机械通气的影响:综合综述与实际应用。
机械通气(MV)为急性低氧性呼吸衰竭患者提供基本的器官支持,急性呼吸窘迫综合征是最严重的形式。使用过大的通气力可加重肺部状况并导致呼吸机诱导的肺损伤(VILI);机械能(ME)或功率可以表征MV过程中施加的力。ME指标将影响呼吸系统(即肺、胸和气道)的所有MV参数合并为一个值。除了评价整体ME外,该参数还可与患者的肺顺应性、患者体重等患者特异性特征相关,进一步提高ME对肺通气积极程度的评价价值。高ME与不良预后相关,可作为VILI风险的预后参数和指标。由于计算复杂且基于多个方程,因此在日常实践中很少确定代谢能。虽然低ME并不能决定性地预防VILI的可能性(例如,由于肺的不均匀性和先前存在的损伤),但考虑到ME的个体化MV设置似乎可以改善结果。本文旨在回顾床边评估机械动力的作用,它在机械通气中的相关性,以及它与治疗结果的关联。此外,我们还讨论了ME的测定方法,旨在为ME概念在日常实践中的临床应用提出最合适的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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