Personalized mechanical ventilation in acute respiratory distress syndrome

Critical Care

John G. Laffey¹  Lorenzo Ball²  Paolo Pelosi²  Sheila N. Myatra³  Luciano Gattinoni⁴  Rinaldo Bellomo⁵  Sharon Einav⁶  Karen E. A. Burns⁷  Patricia R. M. Rocco⁸  Marcus J. Schultz⁹  Carmen S. V. Barbas^1,10  Jean Louis Teboul^1,11  John J. Marini^1,12 

[1] Anaesthesia and Intensive Care Medicine, University Hospital Galway, and School of Medicine, National University of Ireland;Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience;Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute;Department of Anaesthesiology, Emergency, and Intensive Care Medicine, University of Göttingen;Department of Intensive Care, Austin Hospital;Intensive Care Unit of the Shaare Zedek Medical Medical Centre, Hebrew University Faculty of Medicine;Interdepartmental Division of Critical Care Medicine, University of Toronto;Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro;Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University;Pneumology and Intensive Care Medicine, University of São Paulo;Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Inserm UMR S_999, AP-HP Université Paris-Saclay;University of Minnesota and Regions Hospital;

关键词: Tidal volume;    Driving pressure;    Transpulmonary pressure;    Phenotype;    Biomarkers;    Chest computed tomography scan;   

DOI  :  10.1186/s13054-021-03686-3

来源: DOAJ

【 摘 要 】

Abstract A personalized mechanical ventilation approach for patients with adult respiratory distress syndrome (ARDS) based on lung physiology and morphology, ARDS etiology, lung imaging, and biological phenotypes may improve ventilation practice and outcome. However, additional research is warranted before personalized mechanical ventilation strategies can be applied at the bedside. Ventilatory parameters should be titrated based on close monitoring of targeted physiologic variables and individualized goals. Although low tidal volume (V T) is a standard of care, further individualization of V T may necessitate the evaluation of lung volume reserve (e.g., inspiratory capacity). Low driving pressures provide a target for clinicians to adjust V T and possibly to optimize positive end-expiratory pressure (PEEP), while maintaining plateau pressures below safety thresholds. Esophageal pressure monitoring allows estimation of transpulmonary pressure, but its use requires technical skill and correct physiologic interpretation for clinical application at the bedside. Mechanical power considers ventilatory parameters as a whole in the optimization of ventilation setting, but further studies are necessary to assess its clinical relevance. The identification of recruitability in patients with ARDS is essential to titrate and individualize PEEP. To define gas-exchange targets for individual patients, clinicians should consider issues related to oxygen transport and dead space. In this review, we discuss the rationale for personalized approaches to mechanical ventilation for patients with ARDS, the role of lung imaging, phenotype identification, physiologically based individualized approaches to ventilation, and a future research agenda.

【 授权许可】

Unknown