减少呼吸机相关性肺损伤的新方法

尽管了解ARDS的发病机制及其各种影响患者预后的演变因素,机械通气支持仍然是治疗ARDS的基础,但是机械通气本身可以通过多种机制共同加重或引起肺部损伤,统称为呼吸机相关性肺损伤(VILI)。随着对ARDS更深入的了解,VILI在设计肺保护性通气策略过程中已经受到重视,目的是减轻VILI和改善预后。本文旨在阐述VILI的病理生理机制,讨论NAVA、体外生命支持、抗细胞因子疗法等新的减轻和治疗VILI的方法,并通过一些实验研究来证实这些观念。

Novel approaches to minimize ventilator-induced lung injury

Despite over 40 years of research, there is no specific lung-directed therapy for the acute respiratory distress syndrome（ARDS）.Although much has evolved in our understanding of its pathogenesis and factors affecting patient outcome, supportive care with mechanical ventilation remains the cornerstone of treatment. Perhaps the most important advance in ARDS research has been the recognition that mechanical ventilation, although necessary to preserve life, can itself aggravate or cause lung damage through a variety of mechanisms collectively referred to as ventilator- induced lung injury （VILI）. This improved understanding of ARDS and VILI has been important in designing lungprotective ventilatory strategies aimed at attenuating VIL1 and improving outcomes. Considerable effort has been made to enhance our mechanistic understanding of VILI and to develop new ventilatory strategies and therapeutic interventions to prevent and ameliorate VILI with the goal of improving outcomes in patients with ARDS. In this review, we will review the pathophysiology of VILI, discuss a number of novel physiological approaches for minimizing VILI, therapies to counteract biotrauma, and highlight a number of experimental studies to support these concepts.