医学
急性呼吸窘迫综合征
呼吸系统
重症监护医学
机械通风
呼吸控制
通风(建筑)
镇静
麻醉
呼吸生理学
呼吸窘迫
内科学
肺
机械工程
工程类
作者
Elena Spinelli,Tommaso Mauri,Jeremy R. Beitler,Antonio Pesenti,Daniel Brodie
标识
DOI:10.1007/s00134-020-05942-6
摘要
Neural respiratory drive, i.e., the activity of respiratory centres controlling breathing, is an overlooked physiologic variable which affects the pathophysiology and the clinical outcome of acute respiratory distress syndrome (ARDS). Spontaneous breathing may offer multiple physiologic benefits in these patients, including decreased need for sedation, preserved diaphragm activity and improved cardiovascular function. However, excessive effort to breathe due to high respiratory drive may lead to patient self-inflicted lung injury (P-SILI), even in the absence of mechanical ventilation. In the present review, we focus on the physiological and clinical implications of control of respiratory drive in ARDS patients. We summarize the main determinants of neural respiratory drive and the mechanisms involved in its potentiation, in health and ARDS. We also describe potential and pitfalls of the available bedside methods for drive assessment and explore classical and more “futuristic” interventions to control drive in ARDS patients.
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