Lung protective sedation: emphasize bedside assessment of respiratory drive and inspiratory effort

doi:10.3877/cma.j.issn.2096-1537.2024.04.002

Abstract

Abstract:

Analgesia and sedation play important roles in critically ill patients, with the target shifting from improving patient comfort to organ function protection.For mechanically ventilated patients,the newly proposed concept of lung-protective sedation represents a further understanding of the inherent interconnection between optimizing mechanical ventilation, sedation strategies, and respiratory-related lungdiaphragm injuries.It also reminds clinicians that in the analgesic and sedation management of mechanically ventilated patients, they should evaluate and regulate respiratory drive and inspiratory effort in a targeted manner based on the arousal scale assessments to achieve the purpose of lung-diaphragm protective ventilation.

Key words: Sedation, Mechanical ventilation, Organ protection, Monitoring

Mingyue Miao, Jianxin Zhou. Lung protective sedation: emphasize bedside assessment of respiratory drive and inspiratory effort[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(04): 325-328.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2024.04.002

https://icu.cma-cmc.com.cn/EN/Y2024/V10/I04/325

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References 27

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方法	优点	局限性	正常参考值范围（cmH₂O）
P_0.1	（1）无创，易获取；	（1）仅测量初始100 ms 的压力下降，无法代替每次吸气实际用力程度；	1.1～4.0^[19]
	（2）部分呼吸机可自动测量；可反映中枢呼吸驱动	（2）同一患者不同呼吸之间变异度大，需多次重复测量减小误差
ΔP_OCC	（1）无创，易测量；	（1）无法实现连续测量；	5～10 ^[22-23]
	（2）可反映吸气努力过度和动态跨肺压过高	（2）部分呼吸机不支持呼气末气道阻断，无法测量；
		（3）可能会低估部分患者的吸气努力和跨肺压
PMI	（1）无创，易测量；	（1）部分患者无法诱导出满足测量标准的气道平台压；	0～2 ^[25]
	（2）评估吸气努力的准确性较好；	（2）部分呼吸机不支持吸气末气道阻断，无法测量
	（3）可同时测得准静态呼吸系统顺应性

方法	优点	局限性	正常参考值范围（cmH₂O）
P_0.1	（1）无创，易获取；	（1）仅测量初始100 ms 的压力下降，无法代替每次吸气实际用力程度；	1.1～4.0^[19]
	（2）部分呼吸机可自动测量；可反映中枢呼吸驱动	（2）同一患者不同呼吸之间变异度大，需多次重复测量减小误差
ΔP_OCC	（1）无创，易测量；	（1）无法实现连续测量；	5～10 ^[22-23]
	（2）可反映吸气努力过度和动态跨肺压过高	（2）部分呼吸机不支持呼气末气道阻断，无法测量；
		（3）可能会低估部分患者的吸气努力和跨肺压
PMI	（1）无创，易测量；	（1）部分患者无法诱导出满足测量标准的气道平台压；	0～2 ^[25]
	（2）评估吸气努力的准确性较好；	（2）部分呼吸机不支持吸气末气道阻断，无法测量
	（3）可同时测得准静态呼吸系统顺应性

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