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lung-protective ventilation in Patients with Brain Injury： A Multicenter Cross-sectional Study and Questionnaire Survey in China

引用

Chinese Medical Journal 2016年第14期129卷 1643-1651页

作者： Xu-Ying Luo Ying-Hong Hu Xiang-Yuan Cao Yan Kang Li-Ping Liu Shou-Hong Wang Rong-Guo Yu Xiang-You Yu Xia Zhang Bao-Shan Li Zeng-Xiang Ma Yi-Bing Weng Heng Zhang De-Chang Chen Wei Chen Wen-Jin Chen Xiu-Mei Chen Bin Du Mei-Li Duan Jin Hu Yun-Feng Hoang Gui-Jun Jia Li-Hong Li Yu-Min Liang Bing-Yu Qin Xian-Dong Wang Jian Xiong Li-Mei Yan Zheng-Ping Yang Chen-Ming Dong Dong-Xin Wang Qing-Yuan Zhan Shuang-Lin FU Lin Zhao Qi-Bing Huang Ying-Guang Xie Xiao-Bo Huang Guo-Bin Zhang Wang-Bin Xu Yuan Xu YaLing Liu He-Ling Zhao Rong-Qing Sun Ming Sun Qing-Hong Cheng Xin Qu Xiao-Feng Yang Ming Xu Zhong-Hua Shi Han Chen Xuan He Yan-Lin Yang Guang-Qiang Chen Xiu-Mei Sun Jian-Xin Zhou Department of Critical Care Medicine Beijing Tiantan Hospital Capital Medical University Beijing 100050 China Department of Critical Care Medicine Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou Zhejiang 310009 China Department of Critical Care Medicine General Hospital of Ningxia Medical University Yinchuan Ningxia 750004 China Department of Critical Care Medicine West China Hospital Sichuan University Chengdu Sichuan 610041 China Neurological Intensive Care Unit Beijing Tiantan Hospital Capital Medical University Beijing 100050 China Department of Critical Care Medicine Guangdong General Hospital Guangzhou Guangdong 510000 China Surgical Intensive Care Unit Fujian Province Hospital Fuzhou Fujian 350000 China Department of Critical Care Medicine First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang 830054 China Department of Critical Care Medicine Bethune International Peace Hospital Shijiazhuang Hebei 050000 China Department of Critical Care Medicine Yuncheng Central Hospital Yuncheng Shanxi 044000 China Department of Emergency and Critical Care Medicine Cangzhou People's Hospital Cangzhou Hebei 061000 China Department of Critical Care Medicine Beijing Luhe Hospital Capital Medical University Beijing 101100 China Department of Critical Care Medicine First Hospital of China Medical University Shenyang Liaoning 110000 China Department of Critical Care Medicine Shanghai Changzheng Hospital Shanghai 200000 China Department of Critical Care Medicine Beijing Shijitan Hospital Capital Medical University Beijing 100038 China Department of Critical Care Medicine Xuanwu Hospital Capital Medical University Beijing 100053 China Department of Critical Care Medicine Miyun County Hospital Beijing 100038 China Medical Intensive Care Unit Peking Union Medical College Hospital Beijing 101500 China Department of Critical Care Medicine Beijing Friendship Hospital Capital Medical University Beijing 100050 Chin

Background： Over the years, the mechanical ventilation （MV） strategy has changed worldwide. The aim of the present study was to describe the ventilation practices, particularly lung-protective ventilation （LPV）, among brain-injured patients in China. Methods： This study was a multicenter, 1-day, cross-sectional study in 47 Intensive Care Units （ICUs） across China. Mechanically ventilated patients （18 years and older） with brain injury in a participating ICU during the time of the study, including traumatic brain injury, stroke, postoperation with intracranial tumor, hypoxic-ischemic encephalopathy, intracranial infection, and idiopathic epilepsy, were enrolled. Demographic data, primary diagnoses, indications for MV, MV modes and settings, and prognoses on the 60th day were collected. Multivariable logistic analysis was used to assess factors that might affect the use of LPV. Results： A total of 104 patients were enrolled in the present study, 87 （83.7%） of whom were identified with severe brain injury based on a Glasgow Coma Scale 〈8 points. Synchronized intermittent mandatory ventilation （SIMV） was the most frequent ventilator mode, accounting for 46.2% of the entire cohort. The median tidal volume was set to 8.0 ml/kg （interquartile range [IQR], 7.0-8.9 ml/kg） of the predicted body weight; 50 （48.1%） patients received LPV. The median positive end-expiratory pressure （PEEP） was set to 5 cmH20 （IQR, 5-5 cmH20）. No PEEP values were higher than 10 cmH20. Compared with partially mandatory ventilation, supportive and spontaneous ventilation practices were associated with LPV. There were no significant differences in mortality and MV duration between patients subjected to LPV and those were not. Conclusions： Among brain-injured patients in China, SIMV was the most frequent ventilation mode. Nearly one-half of the brain-injured patients received LPV. Patients under supportive and spontaneous ventilation were more likely to receive LPV.

关键词： Brain Injury Epidemiology lung-protective ventilation Mechanical ventilation

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Progress of mechanical power in the intensive care unit

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Chinese Medical Journal 2020年第18期133卷 2197-2204页

作者： Yi Chi Huai-Wu He Yun Long Department of Critical Care Medicine Peking Union Medical College HospitalChinese Academy of Medical SciencesBeijing 100730China

Mechanical power of ventilation,currently defined as the energy delivered from the ventilator to the respiratory system over a period of time,has been recognized as a promising indicator to evaluate ventilator-induced lung injury and predict the prognosis of ventilated critically ill patients.Mechanical power can be accurately measured by the geometric method,while simplified equations allow an easy estimation of mechanical power at the bedside.There may exist a safety threshold of mechanical power above which lung injury is inevitable,and the assessment of mechanical power might be helpful to determine whether the extracorporeal respiratory support is needed in patients with acute respiratory distress syndrome.It should be noted that relatively low mechanical power does not exclude the possibility of lung injury.lung size and inhomogeneity should also be taken into consideration.Problems regarding the safety limits of mechanical power and contribution of each component to lung injury have not been determined yet.Whether mechanical power-directed lung-protective ventilation strategy could improve clinical outcomes also needs further investigation.Therefore,this review discusses the algorithms,clinical relevance,optimization,and future directions of mechanical power in critically ill patients.

关键词： Mechanical power Mechanical energy Ventilator-induced lung injury lung-protective ventilation Acute respiratory distress syndrome

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