急性呼吸窘迫综合征的呼气末正压我们去过哪里,我们要去哪里?

Sara Salah Yusuf Radhi, R. C Freebairn, Y. Chiew, J. Chase, M. Cove
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引用次数: 0

摘要

ARDS是一种异质性综合征,死亡率高,治疗策略有限。正压通气作为保护性肺通气策略的一部分常规应用于这些患者,因为正确使用正压通气有助于优化呼吸系统顺应性并改善氧合。但是,如果PEEP过低或过高,都可能造成伤害。针对急性呼吸窘迫综合征(ARDS)患者的大型临床试验通常比较了低PEEP和高PEEP的策略。没有更好的策略出现,也许是因为这些研究没有根据患者对高或低PEEP的可能反应对患者进行分层。然而,确定最佳PEEP的最佳策略仍然存在争议,尽管在过去50年中进行了许多大型研究。在个性化医疗的现代,也许我们的PEEP策略不应该是高PEEP或低PEEP,而是个性化的PEEP。在这篇文章中,我们回顾了PEEP的生理作用和各种研究方法,并在床边确定最佳PEEP,为定期管理机械通气患者的医生提供指导,并强调了新的研究途径。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Positive end-expiratory pressure in acute respiratory distress syndrome; where have we been, where are we going?
ARDS is a heterogenous syndrome with a high mortality rate and limited therapeutic strategies. PEEP is routinely applied to these patients as a part of a protective lung ventilation strategy because getting it right helps optimize respiratory system compliance and improve oxygenation. However, if the PEEP is too low or too high, it may cause harm. Large clinical trials, focusing on patients with ARDS, have generally compared strategies designed to deliver low PEEP with those designed to deliver higher PEEP. No superior strategy has emerged, perhaps because these studies did not stratify patients based on their likely response to high or low PEEP. Nevertheless, the best strategy to identify optimal PEEP remains controversial, despite many large studies over the past 50 years. In the modern era of personalized medicine, perhaps our PEEP strategy should not be high PEEP or low PEEP but individualized PEEP. In this manuscript, we review the physiological effects of PEEP and the various methods studied and available to determine optimal PEEP at the bedside, providing a guide for physicians who regularly manage mechanically ventilated patients and highlighting new avenues for research.
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