用于肺和横膈膜保护镇静的挥发性麻醉剂

IF 8.8 1区 医学 Q1 CRITICAL CARE MEDICINE
Lukas M. Müller-Wirtz, Brian O’Gara, Marcelo Gama de Abreu, Marcus J. Schultz, Jeremy R. Beitler, Angela Jerath, Andreas Meiser
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引用次数: 0

摘要

本综述探讨了镇静与有创通气之间复杂的相互作用,并研究了挥发性麻醉剂在肺和膈肌保护镇静方面的潜力。在有创通气的早期阶段,许多重症患者的呼吸动力和呼吸强度不足,导致膈肌功能受损。与普通静脉注射药物相比,吸入挥发性麻醉剂镇静能更好地保持呼吸动力,从而有可能在长时间有创通气期间帮助维持横膈膜功能。反过来,较高浓度的挥发性麻醉剂也会减少自发产生的潮气量,从而有可能减少肺部压力和负荷,进而降低自伤肺部的风险。总之,吸入镇静剂可以调节呼吸驱动力,将吸气量维持在肺和膈肌保护范围内。特别是对于预计需要长期有创通气的患者,恢复足够但安全的吸气力度对其成功断奶至关重要,吸入镇静是一种具有吸引力的肺和膈肌保护性镇静选择。技术上的限制是挥发性麻醉剂反射器带来的通气死腔,尽管这种影响微乎其微,与使用热交换器和湿度交换器的通气效果相当。要全面了解吸入镇静对呼吸驱动力和呼吸努力的具体影响,以及最终如何将其转化为危重病人以患者为中心的治疗效果,进一步的研究势在必行。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Volatile anesthetics for lung- and diaphragm-protective sedation
This review explores the complex interactions between sedation and invasive ventilation and examines the potential of volatile anesthetics for lung- and diaphragm-protective sedation. In the early stages of invasive ventilation, many critically ill patients experience insufficient respiratory drive and effort, leading to compromised diaphragm function. Compared with common intravenous agents, inhaled sedation with volatile anesthetics better preserves respiratory drive, potentially helping to maintain diaphragm function during prolonged periods of invasive ventilation. In turn, higher concentrations of volatile anesthetics reduce the size of spontaneously generated tidal volumes, potentially reducing lung stress and strain and with that the risk of self-inflicted lung injury. Taken together, inhaled sedation may allow titration of respiratory drive to maintain inspiratory efforts within lung- and diaphragm-protective ranges. Particularly in patients who are expected to require prolonged invasive ventilation, in whom the restoration of adequate but safe inspiratory effort is crucial for successful weaning, inhaled sedation represents an attractive option for lung- and diaphragm-protective sedation. A technical limitation is ventilatory dead space introduced by volatile anesthetic reflectors, although this impact is minimal and comparable to ventilation with heat and moisture exchangers. Further studies are imperative for a comprehensive understanding of the specific effects of inhaled sedation on respiratory drive and effort and, ultimately, how this translates into patient-centered outcomes in critically ill patients.
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来源期刊
Critical Care
Critical Care 医学-危重病医学
CiteScore
20.60
自引率
3.30%
发文量
348
审稿时长
1.5 months
期刊介绍: Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.
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