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ID 117964
Title Alternative
Trends in mechanical ventilation strategies for acute respiratory failure
人工呼吸戦略up to date
Author
Keywords
Mechanical ventilation
Acute respiratory distress syndrome
Ventilator-induced lung injury
Diaphragm injury
Content Type
Journal Article
Description
In the second half of the 20th century, the polio epidemic led to dramatic advances in positive pressure mechanical ventilation. However, it has become known that mechanical ventilation itself exacerbates lung injury and increase mortality (ventilator-induced lung injury, VILI). Over the past 20 years, numerous studies have been conducted to minimize the risk of VILI, and lung protective ventilation strategies consisting of low tidal volume, low plateau and driving pressure, and the use of appropriate end-expiratory positive pressure, became standard of care for acute respiratory distress syndrome (ARDS).
Furthermore, in recent years, it has revealed that excessive respiratory effort exacerbates lung injury (patient self-inflicted lung injury, P-SILI), and the importance of controlling excessive respiratory effort has been recognized. However, strong suppression of respiratory effort leads to diaphragm atrophy, which may affect patient outcomes. Therefore, lung- and diaphragm-protective ventilation, which consists of monitoring respiratory effort closely and maintaining the effort at an appropriate level, has been proposed as a concept to avoid diaphragm atrophy while preventing P-SILI.
Nevertheless, the mortality rate of ARDS is still high. Today, there is a need to move away from standardized treatment and to tailor ventilatory management to the individual risk of each patient.
Journal Title
Shikoku Acta Medica
ISSN
00373699
NCID
AN00102041
Publisher
徳島医学会
Volume
78
Issue
5-6
Start Page
155
End Page
162
Sort Key
155
Published Date
2022-12-25
FullText File
language
jpn
TextVersion
Publisher
departments
Medical Sciences