摘要
呼吸危重症领域在2021年度(2020年10月1日到2021年9月30日)有了一些临床进展,重症肺炎发病早期、高炎性反应和病情较重的患者应用糖皮质激素有效;右美托咪定对年龄>65岁和外科术后有创机械通气患者能够获益;在呼吸支持领域,经鼻高流量湿化氧疗用于慢性阻塞性肺疾病急性发作、经鼻高流量湿化氧疗联合清醒俯卧位通气、有创机械通气患者采用电阻抗交点法指导滴定呼气末正压、早期应用体外膜氧合、结合神经调节辅助通气指导尽快撤机等相关研究,说明在动态评估的基础上采取个体化呼吸支持的重要性,这些研究成果相信也会对呼吸危重症患者临床救治提供证据支持。
In this review,we outlined the clinical studies in critical care field of pulmonary medicine from November 1,2020 to September 30,2021.A Chinese retrospective study for critically ill patients with COVID-19 showed that corticosteroid therapy was associated with a reduced 28-day mortality in patients with the hyperinflammatory phenotype.In hospitalized patients with COVID-19,the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization,and early sedation with dexmedetomidine exhibited a high probability of reduced 90-day mortality in older patients regardless of operative or non-operative cluster status.High-flow nasal cannula(HFNC)improved the prognosis compared with conventional oxygen therapy in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients with acute compensated hypercapnic respiratory failure.For COVID-19 patients suffering from acute respiratory failure with HFNC therapy,awake prone positioning reduces the incidence of treatment failure and the need for intubation.Compared with pressure-volume curve guiding positive end-expiratory pressure(PEEP)titration for acute respiratory distress syndrome(ARDS)patients,PEEP titration guided with EIT(Electrical impedance tomography)might be associated with improved driving pressure and survival rate.Extracorporeal membrane oxygenation(ECMO)is a life-saving therapy for severe ARDS patients,but the survival among ECMO-assisted patients with COVID-19 is strongly associated with a centre′s experience in ECMO during the previous year and early ECMO management.Compared to conventional lung-protective mechanical ventilation(MV),neurally adjusted ventilatory assist(NAVA)decreased duration of MV.These findings also provide evidence for improving the clinical management in critical care of pulmonary medicine.
作者
宋立成
解立新
Song Licheng;Xie Lixin(College of Pulmonary&Critical Care Medicine,Chinese PLA General Hospital,Beijing 100710,China)
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2022年第1期83-87,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
国家科技部重点课题(2021YFC0122500)。
