Pathophysiology and Prevention of Manual-Ventilation-Induced Lung Injury (MVILI).

IF 2.7 Q2 PATHOLOGY
Luke A White, Steven A Conrad, Jonathan Steven Alexander
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引用次数: 0

Abstract

Manual ventilation, most commonly with a bag-valve mask, is a form of short-term ventilation used during resuscitative efforts in emergent and out-of-hospital scenarios. However, compared to mechanical ventilation, manual ventilation is an operator-dependent skill that is less well controlled and is highly subject to providing inappropriate ventilation to the patient. This article first reviews recent manual ventilation guidelines set forth by the American Heart Association and European Resuscitation Council for providing appropriate manual ventilation parameters (e.g., tidal volume and respiratory rate) in different patient populations in the setting of cardiopulmonary resuscitation. There is then a brief review of clinical and manikin-based studies that demonstrate healthcare providers routinely hyperventilate patients during manual ventilation, particularly in emergent scenarios. A discussion of the possible mechanisms of injury that can occur during inappropriate manual hyperventilation follows, including adverse hemodynamic alterations and lung injury such as acute barotrauma, gastric regurgitation and aspiration, and the possibility of a subacute, inflammatory-driven lung injury. Together, these injurious processes are described as manual-ventilation-induced lung injury (MVILI). This review concludes with a discussion that highlights recent progress in techniques and technologies for minimizing manual hyperventilation and MVILI, with a particular emphasis on tidal-volume feedback devices.

手动通气诱发肺损伤 (MVILI) 的病理生理学与预防。
手动通气(最常见的是使用袋阀面罩)是在急救和院外复苏过程中使用的一种短期通气方式。然而,与机械通气相比,手动通气是一种依赖于操作者的技能,其可控性较差,极易为患者提供不适当的通气。本文首先回顾了美国心脏协会和欧洲复苏委员会最近制定的手动通气指南,该指南针对心肺复苏中不同患者群体提供适当的手动通气参数(如潮气量和呼吸频率)。然后简要回顾了临床研究和基于人体模型的研究,这些研究表明医护人员在手动通气过程中经常会对患者过度通气,尤其是在紧急情况下。随后讨论了不当人工过度通气可能导致的损伤机制,包括不良血流动力学改变和肺损伤,如急性气压创伤、胃反流和吸入,以及亚急性炎症性肺损伤的可能性。这些损伤过程统称为人工通气诱发肺损伤(MVILI)。本综述最后讨论了最大限度减少人工过度通气和 MVILI 的技术和工艺的最新进展,并特别强调了潮气量反馈装置。
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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来源期刊
Pathophysiology
Pathophysiology Medicine-Pathology and Forensic Medicine
CiteScore
3.10
自引率
0.00%
发文量
48
期刊介绍: Pathophysiology is an international journal which publishes papers in English which address the etiology, development, and elimination of pathological processes. Contributions on the basic mechanisms underlying these processes, model systems and interdisciplinary approaches are strongly encouraged.
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