- 期刊
Adaptive Support Ventilation: Review of the Literature and Clinical Applications
順應性支持型呼吸模式：文獻回顧與臨床應用
摘要
機械通氣是一個複雜的過程，包括了壓力、氣流、容積、以及時間之間的交互作用。理論上，我們將通氣模式簡化成容積控制、壓力控制或雙重控制模式。順應性支持型呼吸模式(Adaptive Support Ventilation, ASV)是一新發展的雙重控制模式，根據呼吸器所測量得到的動態順應性及吐氣的時間常數，自動調整潮氣容積和呼吸次數來達到所預設的每分鐘通氣量。針對順應性支持型呼吸模式的優缺點，過去數年間有一些小型的隨機控制或前瞻觀察性研究結果。順應性支持型呼吸模式對於特定的手術後病人是一種安全的脫離呼吸器的方式；可用於呼吸器依賴病人的脫離；可節省醫療人力及管理；也可減少因呼吸器不當使用引起的肺損傷。但是另一方面在病人發生呼吸窘迫情形時，若不了解發生原因及病人的呼吸生理病理機轉，將造成病人與呼吸器間的不協調，甚至有可能使呼吸窘迫情形惡化或延長脫離過程。未來對順應性支持型呼吸模式進行進一步的大型隨機控制研究，對於釐清其臨床角色及應用方式是有必要的。
關鍵字
無資料並列摘要
Mechanical ventilation is a complex process involving interaction between pressure, flow, volume and time. Simply put, we classify the modes as one of either volume control, pressure control, or dual control. Adaptive support ventilation (ASV) is a newly developed dual control mode, using measured dynamic compliance and time constant, with an automated adjustment of tidal volume and respiratory rate combined to meet the preset minute ventilation. Several small randomized controlled or prospective observational studies have stressed that ASV can be used as a safe weaning mode for specific postoperative and chronically ventilated patient groups, save manpower and management, and reduce lung injury induced by mechanical ventilation. However, there is concern about the issue of asynchrony between ventilators and patients if there was no awareness of the underlying mechanism for respiratory distress in the patients, which would possibly worsen the patient's condition or prolong the weaning process. ASV should undergo large randomized controlled studies to clarify its role in clinical practice in the future.