Safer ventilation of the injured lung one step closer 英文参考文献.docVIP

Marini Critical Care 2010,14:192 /content/14/4/192 COMMENTARY Safer ventilation of the injured lung: one step closer John J Marini* See related research by Bikker et al., /content/14/3/R100 and, more recently, de? ation curve de? ection points have Abstract been suggested to o? er the needed guidance [3,5-7]. Prevention of iatrogenic injury due to ventilation of a heterogeneous lung requires knowledge of dynamic regional events occurring within the tidal cycle. Quantitative bedside imaging techniques that are sensitive to regional mechanics and tidal events hold potential for information delivery that cannot be realized by pressure–volume monitoring alone. Although super? cially attractive because airway pressure data are easy to acquire, the idea that any airway pressure-based measurement – used alone – can provide enough information to simultaneously avoid widespread lung over stretch and tidal recruitment seems conceptually na?ve. For the airway pressure to re? ect lung characteristics, two conditions must ? rst be met: the chest wall should not contribute unduly to the recorded airway pressure, and respiratory muscle tone must be low. It is sobering to In the previous issue, Bikker and colleagues demonstrate that electrical impedance tomography has the potential realize that none of the in? uential clinical trials of to track regional ventilation responses to decremental ventilatory pattern that now underpin our evidence base e perceptions that a positive end-expiratory pressure semiquantitatively in assured either pre-requisit patients with acute lung injury [1], suggesting the plateau pressure of 25 cmH O is consistently safe or that 2 potential to predict the consequences of our setting a plateau exceeding 35 cmH O is always dangerous are 2 choices. Such innovations are needed, as our search to thus susp