{"title":"ARDS机械通气策略优化:驱动压力和低潮气量通气的作用。","authors":"Vladislav Muldiiarov, Keely L Buesing","doi":"10.1155/ccrp/8857930","DOIUrl":null,"url":null,"abstract":"<p><p><b>Importance:</b> Mechanical ventilation is indispensable for the management of acute respiratory distress syndrome (ARDS), yet suboptimal ventilator settings can exacerbate lung injury. There is growing evidence that lung-protective ventilation strategies reduce ventilator-induced lung injury (VILI) and improve outcomes. Understanding the role of key parameters, such as driving pressure and tidal volume, is essential for optimizing patient care. <b>Observations:</b> This narrative review synthesizes the evidence underpinning the evolution of lung-protective ventilation strategies in ARDS, focusing on the importance of low tidal volume ventilation and the monitoring of driving pressure. A targeted literature search was performed in PubMed, Embase, The Cochrane Library, Google Scholar, and Web of Science up to April 2025, focusing on adult ARDS. Original research studies (randomized controlled trials, retrospective and prospective cohort studies) and meta-analyses published in English were included. <b>Conclusions and Relevance:</b> Evidence supports adopting lung-protective strategies, including low tidal volume ventilation and careful driving pressure monitoring, to reduce VILI and improve survival in ARDS patients. By integrating these evidence-based principles into mechanical ventilation management, clinicians can enhance patient outcomes, reduce iatrogenic harm, and advance the overall quality of ARDS care.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"8857930"},"PeriodicalIF":1.8000,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317819/pdf/","citationCount":"0","resultStr":"{\"title\":\"Optimizing Mechanical Ventilation Strategies in ARDS: The Role of Driving Pressure and Low Tidal Volume Ventilation.\",\"authors\":\"Vladislav Muldiiarov, Keely L Buesing\",\"doi\":\"10.1155/ccrp/8857930\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Importance:</b> Mechanical ventilation is indispensable for the management of acute respiratory distress syndrome (ARDS), yet suboptimal ventilator settings can exacerbate lung injury. There is growing evidence that lung-protective ventilation strategies reduce ventilator-induced lung injury (VILI) and improve outcomes. Understanding the role of key parameters, such as driving pressure and tidal volume, is essential for optimizing patient care. <b>Observations:</b> This narrative review synthesizes the evidence underpinning the evolution of lung-protective ventilation strategies in ARDS, focusing on the importance of low tidal volume ventilation and the monitoring of driving pressure. A targeted literature search was performed in PubMed, Embase, The Cochrane Library, Google Scholar, and Web of Science up to April 2025, focusing on adult ARDS. Original research studies (randomized controlled trials, retrospective and prospective cohort studies) and meta-analyses published in English were included. <b>Conclusions and Relevance:</b> Evidence supports adopting lung-protective strategies, including low tidal volume ventilation and careful driving pressure monitoring, to reduce VILI and improve survival in ARDS patients. By integrating these evidence-based principles into mechanical ventilation management, clinicians can enhance patient outcomes, reduce iatrogenic harm, and advance the overall quality of ARDS care.</p>\",\"PeriodicalId\":46583,\"journal\":{\"name\":\"Critical Care Research and Practice\",\"volume\":\"2025 \",\"pages\":\"8857930\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-07-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317819/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care Research and Practice\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1155/ccrp/8857930\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Research and Practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/ccrp/8857930","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
重要性:机械通气对于急性呼吸窘迫综合征(ARDS)的治疗是必不可少的,但不理想的呼吸机设置会加重肺损伤。越来越多的证据表明,肺保护性通气策略可以减少呼吸机诱导的肺损伤(VILI)并改善预后。了解关键参数的作用,如驱动压力和潮汐量,对于优化患者护理至关重要。观察:本综述综合了支持ARDS肺保护通气策略演变的证据,重点关注低潮气量通气和驱动压力监测的重要性。在PubMed、Embase、The Cochrane Library、b谷歌Scholar和Web of Science中进行了目标文献检索,检索时间截止到2025年4月,重点关注成人ARDS。原始研究(随机对照试验、回顾性和前瞻性队列研究)和以英语发表的荟萃分析被纳入。结论和相关性:证据支持采用肺保护策略,包括低潮气量通气和仔细的驾驶压力监测,以减少急性呼吸窘迫综合征患者的VILI和提高生存率。通过将这些循证原则整合到机械通气管理中,临床医生可以提高患者的预后,减少医源性伤害,并提高ARDS护理的整体质量。
Optimizing Mechanical Ventilation Strategies in ARDS: The Role of Driving Pressure and Low Tidal Volume Ventilation.
Importance: Mechanical ventilation is indispensable for the management of acute respiratory distress syndrome (ARDS), yet suboptimal ventilator settings can exacerbate lung injury. There is growing evidence that lung-protective ventilation strategies reduce ventilator-induced lung injury (VILI) and improve outcomes. Understanding the role of key parameters, such as driving pressure and tidal volume, is essential for optimizing patient care. Observations: This narrative review synthesizes the evidence underpinning the evolution of lung-protective ventilation strategies in ARDS, focusing on the importance of low tidal volume ventilation and the monitoring of driving pressure. A targeted literature search was performed in PubMed, Embase, The Cochrane Library, Google Scholar, and Web of Science up to April 2025, focusing on adult ARDS. Original research studies (randomized controlled trials, retrospective and prospective cohort studies) and meta-analyses published in English were included. Conclusions and Relevance: Evidence supports adopting lung-protective strategies, including low tidal volume ventilation and careful driving pressure monitoring, to reduce VILI and improve survival in ARDS patients. By integrating these evidence-based principles into mechanical ventilation management, clinicians can enhance patient outcomes, reduce iatrogenic harm, and advance the overall quality of ARDS care.