Research progress in optimized adjustment of driving pressure in lung protective ventilation strategies

doi:10.3760/cma.j.issn.1007-1245.2023.21.002

Abstract

Abstract:

With the increase in the number of patients with mechanical ventilation and the development of enhanced recovery after surgery (ERAS), lung injury caused by mechanical ventilation has attracted much attention. Traditional views suggest that lung protective ventilation strategies can reduce the incidence of ventilator induced lung injury (VILI), but some studies have shown that non-individualized lung protective ventilation strategies have the risk of exacerbating lung injury. At present, there is still controversy in clinical practice on how to formulate individualized lung protective ventilation strategies. The latest researches have found that optimizing the lung protective ventilation strategies through driving pressure can significantly reduce the lung injury and incidence of postoperative pulmonary complications. This article aims to review the current research status of driving pressure in lung protective ventilation strategies.

Key words:

Driving pressure, Lung protective ventilation strategies, Mechanical ventilation, Postoperative pulmonary complications, Progress

摘要：

随着机械通气患者数量的增多和加速康复外科（ERAS）的发展，机械通气引发的肺损伤备受关注。传统观点认为，肺保护性通气策略可以降低呼吸机相关肺损伤（VILI）的发生率，但有研究显示，非个体化的肺保护性通气策略有加重肺损伤的风险。当前，临床对于如何制定个体化肺保护性通气策略仍然存在争议，最新研究发现，通过驱动压优化肺保护性通气策略可以明显减轻肺损伤，降低术后肺部并发症的发生率。该文旨在对驱动压在肺保护性通气策略中的研究现状进行综述。

关键词:

驱动压, 肺保护性通气策略, 机械通气, 术后肺部并发症, 进展

Chen Jixiang, Lu Jing.

Research progress in optimized adjustment of driving pressure in lung protective ventilation strategies [J]. International Medicine and Health Guidance News, 2023, 29(21): 2990-2994.

陈吉祥卢静.

优化调节驱动压在肺保护性通气策略中的研究进展 [J]. 国际医药卫生导报, 2023, 29(21): 2990-2994.

References

[1] Moraes L, Santos CL, Santos RS, et al. Effects of sigh during pressure control and pressure support ventilation in pulmonary and extrapulmonary mild acute lung injury[J]. Crit Care, 2014, 18(4):474. DOI: 10.1186/s13054- 014-0474-4.
[2] Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery[J]. N Engl J Med, 2013, 369(5):428-437. DOI: 10.1056/NEJMoa1301082.
[3] Futier E, Constantin JM, Jaber S. Protective lung ventilation in operating room: a systematic review[J]. Minerva Anestesiol, 2014, 80(6):726-735.
[4] 中华医学会呼吸病学分会呼吸危重症医学学组.急性呼吸窘迫综合征患者机械通气指南(试行)[J].中华医学杂志,2016,96(6):404-424. DOI:10.3760/cma.j.issn.0376-2491. 2016.06.002.
[5] Neto AS, Hemmes SN, Barbas CS, et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data[J]. Lancet Respir Med, 2016, 4(4):272-280. DOI: 10.1016/S2213-2600(16)00057-6.
[6] Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome[J]. N Engl J Med, 2015, 372(8):747-755. DOI: 10.1056/NEJMsa1410639.
[7] Ahn HJ, Park M, Kim JA, et al. Driving pressure guided ventilation[J]. Korean J Anesthesiol, 2020, 73(3):194-204. DOI: 10.4097/kja.20041.
[8] 唐蓉,王迎斌.驱动压指导的肺保护性通气策略在围手术期应用的研究进展[J].国际麻醉学与复苏杂志,2020,41(1):67-70. DOI:10.3760/cma.j.issn.1673-4378.2020.01.015.
[9] Nierhaus A, Frings DP, Braune S, et al. Interventional lung assist enables lung protective mechanical ventilation in acute respiratory distress syndrome[J]. Minerva Anestesiol, 2011, 77(8):797-801.
[10] 诸葛斯亮,骆雪萍.驱动压导向机械通气用于治疗急性呼吸窘迫综合征的研究进展[J].国际医药卫生导报,2020,26(21):3360-3364. DOI:10.3760/cma.j.issn.1007-1245. 2020.21.051.
[11] Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries[J]. JAMA, 2016, 315(8):788-800. DOI: 10.1001/jama. 2016.0291.
[12] Chiumello D, Carlesso E, Brioni M, et al. Airway driving pressure and lung stress in ARDS patients[J]. Crit Care, 2016, 20:276. DOI: 10.1186/s13054-016-1446-7.
[13] 赵婷婷,刘虹,寇夕,等.驱动压在急性呼吸窘迫综合征机械通气中的研究进展[J].国际呼吸杂志,2019,39(19):1517-1520. DOI:10.3760/cma.j.issn.1673- 436X.2019.19.016.
[14] 中华医学会麻醉学分会"围术期肺保护性通气策略临床应用专家共识"工作小组.围术期肺保护性通气策略临床应用专家共识[J].中华麻醉学杂志,2020,40(5):513-519. DOI:10.3760/cma.j.cn131073.20200402.00501.
[15] 杨柠,潘道波.全身麻醉期间肺保护通气策略研究进展[J].国际麻醉学与复苏杂志,2017,38(7):637-641. DOI:10.3760/cma.j.issn.1673-4378.2017.07.015.
[16] Blank RS, Colquhoun DA, Durieux ME, et al. Management of one-lung ventilation: impact of tidal volume on complications after thoracic surgery[J]. Anesthesiology, 2016, 124(6):1286-1295. DOI: 10.1097/ALN.0000000000001100.
[17] Treschan TA, Kaisers W, Schaefer MS, et al. Ventilation with low tidal volumes during upper abdominal surgery does not improve postoperative lung function[J]. Br J Anaesth, 2012, 109(2):263-271. DOI: 10.1093/bja/aes140.
[18] Bugedo G, Retamal J, Bruhn A. Driving pressure: a marker of severity, a safety limit, or a goal for mechanical ventilation? [J]. Crit Care, 2017, 21(1):199. DOI: 10.1186/s13054-017-1779-x.
[19] Halter JM, Steinberg JM, Gatto LA, et al. Effect of positive end-expiratory pressure and tidal volume on lung injury induced by alveolar instability[J]. Crit Care, 2007, 11(1):R20. DOI: 10.1186/cc5695.
[20] Protti A, Andreis DT, Monti M, et al. Lung stress and strain during mechanical ventilation: any difference between statics and dynamics? [J]. Crit Care Med, 2013, 41(4):1046-1055. DOI: 10.1097/CCM.0b013e31827417a6.
[21] Protti A, Votta E, Gattinoni L. Which is the most important strain in the pathogenesis of ventilator-induced lung injury: dynamic or static? [J]. Curr Opin Crit Care, 2014, 20(1):33-38. DOI: 10.1097/MCC.0000000000000047.
[22] Östberg E, Thorisson A, Enlund M, et al. Positive end-expiratory pressure alone minimizes atelectasis formation in nonabdominal surgery: a randomized controlled trial[J]. Anesthesiology, 2018, 128(6):1117-1124. DOI: 10.1097/ALN.0000000000002134.
[23] 薄禄龙,卞金俊,邓小明.手术患者肺保护性通气策略:国际专家组推荐规范的解读[J].国际麻醉学与复苏杂志,2020,41(5):417-421. DOI:10.3760/cma.j.cn321761-20200110- 00020.
[24] Walkey AJ, Del Sorbo L, Hodgson CL, et al. Higher PEEP versus lower PEEP strategies for patients with acute respiratory distress syndrome. A systematic review and meta-analysis[J]. Ann Am Thorac Soc, 2017, 14(Supplement_4):S297-S303. DOI: 10.1513/AnnalsATS.201704-338OT.
[25] Park M, Ahn HJ, Kim JA, et al. Driving pressure during thoracic surgery: a randomized clinical trial[J]. Anesthesiology, 2019, 130(3):385-393. DOI: 10.1097/ALN.0000000000002600.
[26] Pereira SM, Tucci MR, Morais CCA, et al. Individual positive end-expiratory pressure settings optimize intraoperative mechanical ventilation and reduce postoperative atelectasis[J]. Anesthesiology, 2018, 129(6):1070-1081. DOI: 10.1097/ALN.0000000000002435.
[27] 吴峤微,方志宏,缪红军,等.驱动压对急性呼吸窘迫综合征预后影响的系统评价与Meta分析[J].中华急诊医学杂志,2022,31(9):1294-1298. DOI:10.3760/cma.j.issn.1671- 0282.2022.09.027.
[28] Rauf A, Sachdev A, Venkataraman ST, et al. Dynamic airway driving pressure and outcomes in children with acute hypoxemic respiratory failure[J]. Respir Care, 2021, 66(3):403-409. DOI: 10.4187/respcare.08024.
[29] 朱佳羽,姚婧,王子轩,等.驱动压指导PEEP滴定对机器人辅助前列腺癌根治术老年患者肺损伤的影响[J].中华麻醉学杂志,2022,42(1):39-43. DOI:10.3760/cma.j.cn131073. 20211118.00108.
[30] Bellani G, Grassi A, Sosio S, et al. Driving pressure is associated with outcome during assisted ventilation in acute respiratory distress syndrome[J]. Anesthesiology, 2019, 131(3):594-604. DOI: 10.1097/ALN.0000000000002846.
[31] Chen Z, Wei X, Liu G, et al. Higher vs. lower DP for ventilated patients with acute respiratory distress syndrome: a systematic review and meta-analysis[J]. Emerg Med Int, 2019, 2019:4654705. DOI: 10.1155/2019/4654705.
[32] 杨唯奕,石梦竹,刘海林,等.机械通气中驱动压与肺保护通气策略的关系研究进展[J].山东医药,2023,63(5):96-99. DOI:10.3969/j.issn.1002-266X.2023.05.024.