tailieunhanh - Báo cáo y học: "Safer ventilation of the injured lung: one step closer"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Safer ventilation of the injured lung: one step closer. | Marini Critical Care 2010 14 192 http content 14 4 192 CRITICAL CARE COMMENTARY L__ Safer ventilation of the injured lung one step closer John J Marini See related research by Bikker etal. http content 14 3 R100 Abstract 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. In the previous issue Bikker and colleagues demonstrate that electrical impedance tomography has the potential to track regional ventilation responses to decremental positive end-expiratory pressure semiquantitatively in patients with acute lung injury 1 suggesting the potential to predict the consequences of our setting choices. Such innovations are needed as our search to find a reliable means with which to identify the optimal settings for ventilating acute respiratory distress syndrome remains unaccomplished more than 40 years after it began 2 3 . Inappropriate values for end-inspiratory or end-expiratory pressure have clear potential to damage a lung predisposed to ventilator-induced lung injury. Furthermore the driving pressure the difference between plateau and positive end-expiratory pressures as well as the rate at which lung inflation occurs flow magnitude and profile may be additional keys to safety and hazard 4 . Because we face a heterogeneous mechanical environment and multiple variables to be regulated our progress toward forging a trustworthy tool with which to adjust respiratory life support in patients afflicted with acute respiratory distress syndrome has been glacially slow. Over the years static airway pressures tidal compliance calculations contours of the inflation airway pressure-volume curve inflection points stress index Correspondence .