肺保护性通气策略及膈肌保护的关键问题
Key issues of lung protective ventilation strategies and diaphragm protection
- 解放军医学杂志 2023年48卷第11期 页码：1276-1286
- 作者机构：
1.南昌大学医学院麻醉系，江西南昌 330006
2.江西省肿瘤医院麻醉科，江西南昌 330029
- 作者简介：
叶婷，硕士研究生，主要从事围手术期器官保护方面的研究
肖华平，E-mail：ndzlyy1604@ncu.edu.cn
- 基金信息：江西省重点研发计划项目(S2020ZPYFB1754)
DOI：10.11855/j.issn.0577-7402.2542.2023.0920
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叶婷, 肖华平. 肺保护性通气策略及膈肌保护的关键问题[J]. 解放军医学杂志, 2023, 48(11): 1276-1286.
Ye Ting,Xiao Hua-Ping.Key issues of lung protective ventilation strategies and diaphragm protection[J].Medical Journal of Chinese People′s Liberation Army,2023,48(11):1276-1286.
叶婷, 肖华平. 肺保护性通气策略及膈肌保护的关键问题[J]. 解放军医学杂志, 2023, 48(11): 1276-1286. DOI： 10.11855/j.issn.0577-7402.2542.2023.0920.
Ye Ting,Xiao Hua-Ping.Key issues of lung protective ventilation strategies and diaphragm protection[J].Medical Journal of Chinese People′s Liberation Army,2023,48(11):1276-1286. DOI： 10.11855/j.issn.0577-7402.2542.2023.0920.
摘要
随着医学的不断发展与进步，全麻手术总量日益增加，术后并发症的发生也不断增多，尤其是围手术期肺损伤导致的术后肺部并发症(PPCs)。PPCs是导致全麻手术患者住院时间延长、病死率增高、预后不良及医疗负担加重的主要原因。随着对机械通气认识的加深及加速康复外科(ERAS)理念的实施，肺保护性通气策略(LPVS)越来越受到人们的重视。然而，关于如何有效应用LPVS仍存在争议。最近，膈肌保护性通气作为一个新颖的概念被提出并使人们意识到，保护性通气策略的应用应该在肺保护性通气的范围内限制机械通气对膈肌功能的不利影响。如何有效应用保护性通气策略来预防呼吸机相关性肺损伤(VILI)、呼吸机相关性膈肌功能障碍(VIDD)，降低PPCs的发生率，改善患者的预后，并减轻医疗负担是机械通气患者管理中的重要挑战。本文就肺和膈肌联合保护的通气策略，结合LPVS的最新进展，对个体化通气策略的应用研究及VILI、VIDD的发生机制进行阐述，并对未来保护性通气策略的研究方向进行展望。
Abstract
With the continuous development and progress of medicine, the total number of general anesthetic surgery is increasing, and postoperative complications are also on the rise, especially postoperative pulmonary complications (PPCs) caused by perioperative lung injury. PPCs are the main cause of prolonged hospitalization, increased morbidity and mortality, poor prognosis, and increased medical burden in patients undergoing general anesthesia. With the enhancement of awareness of mechanical ventilation and the implementation of the enhanced recovery after surgery (ERAS) concept, lung-protective ventilation strategies (LPVS) are receiving more and more attention. However, the debate continues on how to apply the LPVS effectively. The recent introduction of diaphragm-protective ventilation as a novel concept has led to the realization that the application of protective ventilation strategies should limit the adverse effects of mechanical ventilation on diaphragm function within the context of lung protective ventilation. How to apply protective ventilation strategies effectively to prevent the development of ventilator-induced lung injury (VILI) and ventilator-induced diaphragm dysfunction (VIDD), reduce the incidence of PPCs, improve patient prognosis, and reduce the medical burden is an important challenge in the management of mechanically ventilated patients. In this paper, we will focus on ventilation strategies of lung and diaphragm combined with the latest progress of LPVS, to elaborate the research on the application of individualized ventilation strategies and the mechanisms of VILI and VIDD occurrence. Finally, prospecting the future research direction of protective ventilation strategies.
关键词
全麻机械通气肺部并发症肺保护膈肌保护
Keywords
general anesthesiamechanical ventilationpulmonary complicationslung-protectivediaphragm-protective
references
Weiser TG, Haynes AB, Molina G, et al. Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes[J]. Lancet, 2015, 385(Suppl 2): S11.
Zhong HL, Wang YB. Research progress of respiratory mechanics monitoring in guiding mechanical ventilation of patients with COPD[J]. Med J Chin PLA, 2022, 47(12): 1262-1267.
钟海莲, 王迎斌. 呼吸力学监测指导COPD患者机械通气的研究进展[J]. 解放军医学杂志, 2022, 47(12): 1262-1267.
Odor PM, Bampoe S, Gilhooly D, et al. Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis[J]. BMJ, 2020, 368: m540.
Milot J, Perron J, Lacasse Y, et al. Incidence and predictors of ARDS after cardiac surgery[J]. Chest, 2001, 119(3): 884-888.
Zhang D, Hao W, Li X, et al. Aldh1a1 and Scl25a30 in diaphragmatic dysfunction[J]. Exp Biol Med (Maywood), 2022, 247(12): 1013-1029.
Molina Peña ME, Sánchez CM, Rodríguez-Triviño CY. Physiopathological mechanisms of diaphragmatic dysfunction associated with mechanical ventilation[J]. Rev Esp Anestesiol Reanim (Engl Ed), 2020, 67(4): 195-203.
Schepens T, Goligher EC. Lung- and diaphragm-protective ventilation in acute respiratory distress syndrome: rationale and challenges[J]. Anesthesiology, 2019, 130(4): 620-633.
Zhang D, Hao W, Niu Q, et al. Identification of the co-differentially expressed hub genes involved in the endogenous protective mechanism against ventilator-induced diaphragm dysfunction[J]. Skelet Muscle, 2022, 12(1): 21.
Zhou XL, Wei XJ, Li SP, et al. Lung-protective ventilation worsens ventilator-induced diaphragm atrophy and weakness[J]. Respir Res, 2020, 21(1): 16.
Matthay MA, Zemans RL, Zimmerman GA, et al. Acute respiratory distress syndrome[J]. Nat Rev Dis Primers, 2019, 5(1): 18.
Goligher EC, Dres M, Fan E, et al. Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes[J]. Am J Respir Crit Care Med, 2018, 197(2): 204-213.
Lellouche F, Dionne S, Simard S, et al. High tidal volumes in mechanically ventilated patients increase organ dysfunction after cardiac surgery[J]. Anesthesiology, 2012, 116(5): 1072-1082.
Ziaka M, Makris D, Fotakopoulos G, et al. High-tidal-volume mechanical ventilation and lung inflammation in intensive care patients with normal lungs[J]. Am J Crit Care, 2020, 29(1): 15-21.
Sage M, See W, Nault S, et al. Effect of low versus high tidal-volume total liquid ventilation on pulmonary inflammation[J]. Front Physiol, 2020, 11: 603.
Gattinoni L, Giosa L, Bonifazi M, et al. Targeting transpulmonary pressure to prevent ventilator-induced lung injury[J]. Expert Rev Respir Med, 2019, 13(8): 737-746.
Young CC, Harris EM, Vacchiano C, et al. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations[J]. Br J Anaesth, 2019, 123(6): 898-913.
Rizzo AN, Haeger SM, Oshima K, et al. Alveolar epithelial glycocalyx degradation mediates surfactant dysfunction and contributes to acute respiratory distress syndrome[J]. JCI Insight, 2022, 7(2): e154573.
Zeng C, Lagier D, Lee JW, et al. Perioperative pulmonary atelectasis: Part I. Biology and mechanisms[J]. Anesthesiology, 2022, 136(1): 181-205.
O'Gara B, Talmor D. Perioperative lung protective ventilation[J]. BMJ, 2018, 362: k3030.
Lagier D, Zeng C, Fernandez-Bustamante A, et al. Perioperative pulmonary atelectasis: Part Ⅱ. Clinical implications[J]. Anesthesiology, 2022, 136(1): 206-236.
Guervilly C, Fournier T, Chommeloux J, et al. Ultra-lung-protective ventilation and biotrauma in severe ARDS patients on veno-venous extracorporeal membrane oxygenation: a randomized controlled study[J]. Crit Care, 2022, 26(1): 383.
Lohser J, Slinger P. Lung injury after one-lung ventilation: a review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung[J]. Anesth Analg, 2015, 121(2): 302-318.
Karageorgos V, Proklou A, Vaporidi K. Lung and diaphragm protective ventilation: a synthesis of recent data[J]. Expert Rev Respir Med, 2022, 16(4): 375-390.
Dridi H, Yehya M, Barsotti R, et al. Mitochondrial oxidative stress induces leaky ryanodine receptor during mechanical ventilation[J]. Free Radic Biol Med, 2020, 146: 383-391.
Morris IS, Bassi T, Bellissimo CA, et al. Proof of concept for continuous on-demand phrenic nerve stimulation to prevent diaphragm disuse during mechanical ventilation (STIMULUS): a phase 1 clinical trial[J]. Am J Respir Crit Care Med, 2023. doi: 10.1164/rccm.202305-0791LEhttp://dx.doi.org/10.1164/rccm.202305-0791LE.
Hyatt HW, Ozdemir M, Yoshihara T, et al. Calpains play an essential role in mechanical ventilation-induced diaphragmatic weakness and mitochondrial dysfunction[J]. Redox Biol, 2021, 38: 101802.
Zambon M, Beccaria P, Matsuno J, et al. Mechanical ventilation and diaphragmatic atrophy in critically ill patients: an ultrasound study[J]. Crit Care Med, 2016, 44(7): 1347-1352.
Schepens T, Verbrugghe W, Dams K, et al. The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study[J]. Crit Care, 2015, 19: 422.
Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness[J]. N Engl J Med, 2014, 371(3): 287-288.
Liu H, Weng XJ, Yao JY, et al. Neuregulin-1β protects the rat diaphragm during sepsis against oxidative stress and inflammation by activating the PI3K/Akt pathway[J]. Oxid Med Cell Longev, 2020, 2020: 1720961.
Goligher EC, Jonkman AH, Dianti J, et al. Clinical strategies for implementing lung and diaphragm-protective ventilation: avoiding insufficient and excessive effort[J]. Intensive Care Med, 2020, 46(12): 2314-2326.
Chen Y, Liu Y, Han M, et al. Quantification of diaphragmatic dynamic dysfunction in septic patients by bedside ultrasound[J]. Sci Rep, 2022, 12(1): 17336.
Yoshida T, Roldan R, Beraldo MA, et al. Spontaneous effort during mechanical ventilation: maximal injury with less positive end-expiratory pressure[J]. Crit Care Med, 2016, 44(8): e678-e688.
Hillas G, Perlikos F, Toumpanakis D, et al. Controlled mechanical ventilation attenuates the systemic inflammation of severe chronic obstructive pulmonary disease exacerbations[J]. Am J Respir Crit Care Med, 2016, 193(6): 696-698.
Schreiber A, Bertoni M, Goligher EC. Avoiding respiratory and peripheral muscle injury during mechanical ventilation: diaphragm-protective ventilation and early mobilization[J]. Crit Care Clin, 2018, 34(3): 357-381.
Akoumianaki E, Lyazidi A, Rey N, et al. Mechanical ventilation-induced reverse-triggered breaths: a frequently unrecognized form of neuromechanical coupling[J]. Chest, 2013, 143(4): 927-938.
Lindqvist J, van den Berg M, van der Pijl R, et al. Positive end-expiratory pressure ventilation induces longitudinal atrophy in diaphragm fibers[J]. Am J Respir Crit Care Med, 2018, 198(4): 472-485.
Qian X, Jiang Y, Jia J, et al. PEEP application during mechanical ventilation contributes to fibrosis in the diaphragm[J]. Respir Res, 2023, 24(1): 46.
Goligher EC, Brochard LJ, Reid WD, et al. Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure[J]. Lancet Respir Med, 2019, 7(1): 90-98.
Demoule A, Jung B, Prodanovic H, et al. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study[J]. Am J Respir Crit Care Med, 2013, 188(2): 213-219.
Yang D, Grant MC, Stone A, et al. A meta-analysis of intraoperative ventilation strategies to prevent pulmonary complications: is low tidal volume alone sufficient to protect healthy lungs?[J]. Ann Surg, 2016, 263(5): 881-887.
Hu XY, Du B. Lung-protective ventilation during one-lung ventilation: known knowns, and known unknowns[J]. J Thorac Dis, 2019, 11(Suppl 3): S237-S240.
Levin MA, McCormick PJ, Lin HM, et al. Low intraoperative tidal volume ventilation with minimal PEEP is associated with increased mortality[J]. Br J Anaesth, 2014, 113(1): 97-108.
Deng QW, Tan WC, Zhao BC, et al. Intraoperative ventilation strategies to prevent postoperative pulmonary complications: a network meta-analysis of randomised controlled trials[J]. Br J Anaesth, 2020, 124(3): 324-335.
Mercat A, Richard JCM, Vielle B, et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial[J]. JAMA, 2008, 299(6): 646-655.
Li P, Kang X, Miao M, et al. Individualized positive end-expiratory pressure (PEEP) during one-lung ventilation for prevention of postoperative pulmonary complications in patients undergoing thoracic surgery: a meta-analysis[J]. Medicine (Baltimore), 2021, 100(28): e26638.
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.
Hemmes SNT, Gama de Abreu M, Pelosi P, et al. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial[J]. Lancet, 2014, 384(9942): 495-503.
Zhu Y, Chen X, Wang F, et al. Effect of perioperative mechanical ventilation strategies on postoperative pulmonary complications in patients undergoing thoracic surgery: a meta-analysis[J]. Asian J Surg, 2021, 44(5): 776-777.
Sella N, Pettenuzzo T, Zarantonello F, et al. Electrical impedance tomography: a compass for the safe route to optimal PEEP[J]. Respir Med, 2021, 187: 106555.
Somhorst P, van der Zee P, Endeman H, et al. PEEP-FiO2 table versus EIT to titrate PEEP in mechanically ventilated patients with COVID-19-related ARDS[J]. Crit Care, 2022, 26(1): 272.
Karsten J, Grusnick C, Paarmann H, et al. Positive end-expiratory pressure titration at bedside using electrical impedance tomography in post-operative cardiac surgery patients[J]. Acta Anaesthesiol Scand, 2015, 59(6): 723-732.
Jimenez JV, Munroe E, Weirauch AJ, et al. Electric impedance tomography-guided PEEP titration reduces mechanical power in ARDS: a randomized crossover pilot trial[J]. Crit Care, 2023, 27(1): 21.
Park M, Ahn HJ, Kim JA, et al. Driving pressure during thoracic surgery: a randomized clinical trial[J]. Anesthesiology, 2019, 130(3): 385-393.
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.
Amato MBP, 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.
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.
Laffey JG, Bellani G, Pham T, et al. Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study[J]. Intensive Care Med, 2016, 42(12): 1865-1876.
DESIGNATION–investigators. Driving Pressure During General Anesthesia for Open Abdominal Surgery (DESIGNATION): study protocol of a randomized clinical trial[J]. Trials, 2020, 21(1): 198.
Ferrando C, Soro M, Unzueta C, et al. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial[J]. Lancet Respir Med, 2018, 6(3): 193-203.
Hartland BL, Newell TJ, Damico N. Alveolar recruitment maneuvers under general anesthesia: a systematic review of the literature[J]. Respiratory care, 2015, 60(4): 609-620.
Ferrando C, Suarez-Sipmann F, Tusman G, et al. Open lung approach versus standard protective strategies: effects on driving pressure and ventilatory efficiency during anesthesia - a pilot, randomized controlled trial[J]. PLoS One, 2017, 12(5): e0177399.
Unzueta C, Tusman G, Suarez-Sipmann F, et al. Alveolar recruitment improves ventilation during thoracic surgery: a randomized controlled trial[J]. Br J Anaesth, 2012, 108(3): 517-24.
Writing Committee for the PROBESE Collaborative Group of the PROtective VEntilation Network (PROVEnet) for the Clinical Trial Network of the European Society of Anaesthesiology, Bluth T, Serpa Neto A, et al. Effect of intraoperative high positive end-expiratory pressure (PEEP) with recruitment maneuvers vs low peep on postoperative pulmonary complications in obese patients: a randomized clinical trial[J]. JAMA, 2019, 321(23): 2292-2305.
Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators, Cavalcanti AB, Suzumura ÉA, et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial[J]. JAMA, 2017, 318(14): 1335-1345.
Chiumello D, Dres M, Camporota L. Lung and diaphragm protective ventilation guided by the esophageal pressure[J]. Intensive Care Med, 2022, 48(10): 1302-1304.
Goligher EC, Dres M, Patel BK, et al. Lung- and diaphragm-protective ventilation[J]. Am J Respir Crit Care Med, 2020, 202(7): 950-961.
de Vries HJ, Jonkman AH, de Grooth HJ, et al. Lung- and diaphragm-protective ventilation by titrating inspiratory support to diaphragm effort: a randomized clinical trial[J]. Crit Care Med, 2022, 50(2): 192-203.
Doorduin J, van Hees HWH, van der Hoeven JG, et al. Monitoring of the respiratory muscles in the critically ill[J]. Am J Respir Crit Care Med, 2013, 187(1): 20-27.
Rohrs EC, Bassi TG, Fernandez KC, et al. Diaphragm neurostimulation during mechanical ventilation reduces atelectasis and transpulmonary plateau pressure, preserving lung homogeneity and PaO2/FiO2[J]. J Appl Physiol (1985), 2021, 131(1): 290-301.
Hotz JC, Bornstein D, Kohler K, et al. Real-time effort driven ventilator management: a pilot study[J]. Pediatr Crit Care Med, 2020, 21(11): 933-940.
Liu X, Liu X, Meng J, et al. Electrical impedance tomography for titration of positive end-expiratory pressure in acute respiratory distress syndrome patients with chronic obstructive pulmonary disease[J]. Crit Care, 2022, 26(1): 339.
Itagaki T. Diaphragm-protective mechanical ventilation in acute respiratory failure[J]. J Med Invest, 2022, 69(3.4): 165-172.
Telias I, Junhasavasdikul D, Rittayamai N, et al. Airway occlusion pressure as an estimate of respiratory drive and inspiratory effort during assisted ventilation[J]. Am J Respir Crit Care Med, 2020, 201(9): 1086-1098.
Yoshida T, Fujino Y, Amato MBP, et al. Fifty years of research in ARDS. Spontaneous breathing during mechanical ventilation. risks, mechanisms, and management[J]. Am J Respir Crit Care Med, 2017, 195(8): 985-992.
Kataoka J, Kuriyama A, Norisue Y, et al. Proportional modes versus pressure support ventilation: a systematic review and meta-analysis[J]. Ann Intensive Care, 2018, 8(1): 123.
Vaporidi K. NAVA and PAV+ for lung and diaphragm protection[J]. Curr Opin Crit Care, 2020, 26(1): 41-46.
di Mussi R, Spadaro S, Volta CA, et al. Continuous assessment of neuro-ventilatory drive during 12 h of pressure support ventilation in critically ill patients[J]. Crit Care, 2020, 24(1): 652.
Grasselli G, Castagna L, Abbruzzese C, et al. Pulmonary volume-feedback and ventilatory pattern after bilateral lung transplantation using neurally adjusted ventilatory assist ventilation[J]. Br J Anaesth, 2021, 127(1): 143-152.
Langer T, Baio S, Chidini G, et al. Severe diaphragmatic dysfunction with preserved activity of accessory respiratory muscles in a critically ill child: a case report of failure of neurally adjusted ventilatory assist (NAVA) and successful support with pressure support ventilation (PSV)[J]. BMC Pediatr, 2019, 19(1): 155.
Jonkman AH, Rauseo M, Carteaux G, et al. Proportional modes of ventilation: technology to assist physiology[J]. Intensive Care Med, 2020, 46(12): 2301-2313.
Rodrigues A, Telias I, Damiani LF, et al. Reverse triggering during controlled ventilation: from physiology to clinical management[J]. Am J Respir Crit Care Med, 2023, 207(5): 533-543.
Santa Cruz R, Villarejo F, Irrazabal C, et al. High versus low positive end-expiratory pressure (PEEP) levels for mechanically ventilated adult patients with acute lung injury and acute respiratory distress syndrome[J]. Cochrane Database Syst Rev, 2021, 3(3): CD009098.
Dianti J, Fard S, Wong J, et al. Strategies for lung- and diaphragm-protective ventilation in acute hypoxemic respiratory failure: a physiological trial[J]. Crit Care, 2022, 26(1): 259.
Mehta S, Burry L, Cook D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial[J]. JAMA, 2012, 308(19): 1985-1992.
Demoule A, Clavel M, Rolland-Debord C, et al. Neurally adjusted ventilatory assist as an alternative to pressure support ventilation in adults: a French multicentre randomized trial[J]. Intensive Care Med, 2016, 42(11): 1723-1732.
Vaschetto R, Cammarota G, Colombo D, et al. Effects of propofol on patient-ventilator synchrony and interaction during pressure support ventilation and neurally adjusted ventilatory assist[J]. Crit Care Med, 2014, 42(1): 74-82.
Skrobik Y, Duprey MS, Hill NS, et al. Low-dose nocturnal dexmedetomidine prevents ICU delirium. A randomized, placebo-controlled trial[J]. Am J Respir Crit Care Med, 2018, 197(9): 1147-1156.
Lewis K, Alshamsi F, Carayannopoulos KL, et al. Dexmedetomidine vs other sedatives in critically ill mechanically ventilated adults: a systematic review and meta-analysis of randomized trials[J]. Intensive Care Med, 2022, 48(7): 811-840.
Su X, Meng ZT, Wu XH, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial[J]. Lancet, 2016, 388(10054): 1893-1902.
Spinelli E, Pesenti A, Slobod D, et al. Clinical risk factors for increased respiratory drive in intubated hypoxemic patients[J]. Crit Care, 2023, 27(1): 138.
Combes A, Brodie D, Aissaoui N, et al. Extracorporeal carbon dioxide removal for acute respiratory failure: a review of potential indications, clinical practice and open research questions[J]. Intensive Care Med, 2022, 48(10): 1308-1321.
Crotti S, Bottino N, Spinelli E. Spontaneous breathing during veno-venous extracorporeal membrane oxygenation[J]. J Thorac Dis, 2018, 10(Suppl 5): S661-S669.
Kohara J, Kai S, Hashimoto K, et al. Successful lung-protective ventilatory management during the VV-ECMO in a severe COVID-19 pneumonia patient with extensive pneumomediastinum and subcutaneous emphysema: a case report[J]. JA Clin Rep, 2022, 8(1): 12.
Chanques G, Constantin JM, Devlin JW, et al. Analgesia and sedation in patients with ARDS[J]. Intensive Care Med, 2020, 46(12): 2342-2356.
Reardon PM, Wong J, Fitzpatrick A, et al. Diaphragm function in acute respiratory failure and the potential role of phrenic nerve stimulation[J]. Curr Opin Crit Care, 2021, 27(3): 282-289.
Doorduin J, Nollet JL, Roesthuis LH, et al. Partial neuromuscular blockade during partial ventilatory support in sedated patients with high tidal volumes[J]. Am J Respir Crit Care Med, 2017, 195(8): 1033-1042.
Torbic H, Krishnan S, Harnegie MP, et al. Neuromuscular blocking agents for ARDS: a systematic review and meta-analysis[J]. Respir Care, 2021, 66(1): 120-128.
Torbic H, Duggal A. Neuromuscular blocking agents for acute respiratory distress syndrome[J]. J Crit Care, 2019, 49: 179-184.
Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome[J]. N Engl J Med, 2010, 363(12): 1107-1116.
National Heart, Lung, and Blood Institute PETAL Clinical Trials Network, Moss M, Huang DT, et al. Early neuromuscular blockade in the acute respiratory distress syndrome[J]. N Engl J Med, 2019, 380(21): 1997-2008.
Yang M, Wang H, Han G, et al. Phrenic nerve stimulation protects against mechanical ventilation-induced diaphragm dysfunction in rats[J]. Muscle Nerve, 2013, 48(6): 958-962.
Morris IS, Dres M, Goligher EC. Phrenic nerve stimulation to protect the diaphragm, lung, and brain during mechanical ventilation[J]. Intensive Care Med, 2022, 48(10): 1299-1301.
Meyer NJ, Gattinoni L, Calfee CS. Acute respiratory distress syndrome[J]. Lancet, 2021, 398(10300): 622-637.
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