Application of mechanical ventilation strategy guided by the transpulmonary pressure monitoring in patients with acute respiratory distress syndrome
肖坤 1解立新 1王秋红
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作者信息
1. 解放军总医院呼吸与危重症医学部，北京 100091
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摘要
跨肺压是维持呼气末肺泡开放的关键。通过跨肺压监测可以指导个体化设置呼气末正压，在避免呼气末肺泡萎陷、气道陷闭的同时，评估肺的可复张性；最大程度减少剪切伤和气压伤，改善通气和氧合；提高人机协调性，更好地识别和处理人机对抗，为实施危重症患者个体化机械通气治疗保驾护航。本文针对跨肺压的原理，跨肺压指导急性呼吸窘迫综合征患者进行个体化机械通气参数设置，以及跨肺压监测目前存在的局限性进行了详细阐述。 Transpulmonary pressure is the key event to maintain end-expiratory alveolar opening.Transpulmonary pressure monitoring can guide the individualized setting of positive end-expiratory pressure, avoid end-expiratory alveolar collapse and airway closure, evaluate lung reexpansibility, minimize shear injury and barometric injury, and improve ventilation and oxygenation.It favors the individualized mechanical ventilation treatment for critically ill patients by improving the patient-machine cooridation, identifying the patient-machine resistance and providing relevant interventions.This article thoroughly explains the principles of transpulmonary pressure monitoring and guides the individualized setting of mechanical ventilation parameters for patients with acute respiratory distress syndrome, as well as the current limitations.
Abstract
Transpulmonary pressure is the key event to maintain end-expiratory alveolar opening.Transpulmonary pressure monitoring can guide the individualized setting of positive end-expiratory pressure, avoid end-expiratory alveolar collapse and airway closure, evaluate lung reexpansibility, minimize shear injury and barometric injury, and improve ventilation and oxygenation.It favors the individualized mechanical ventilation treatment for critically ill patients by improving the patient-machine cooridation, identifying the patient-machine resistance and providing relevant interventions.This article thoroughly explains the principles of transpulmonary pressure monitoring and guides the individualized setting of mechanical ventilation parameters for patients with acute respiratory distress syndrome, as well as the current limitations.
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