肺動態順應性與超聲聯合滴定PEEP策略_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

楊沙沙 ¹ ,  王春愛 ²

1. ;
2. ;

Corresponding?author：

王春愛, Email: chunaixx@163.com

Keywords：

DOI：

10.7507/1671-6205.202510052

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Citation： 楊沙沙, 王春愛. 肺動態順應性與超聲聯合滴定PEEP策略. Chinese Journal of Respiratory and Critical Care Medicine, 2026, 25(7): 523-527. doi: 10.7507/1671-6205.202510052 Copy

1.	Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med, 2013, 369(22): 2126-2136.
2.	Fan E, Del Sorbo L, Goligher EC, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med, 2017, 195(9): 1253-1263.
3.	Beitler JR, Sarge T, Banner-Goodspeed VM, et al. Effect of titrating positive end-expiratory pressure (PEEP) with an esophageal pressure-guided strategy vs an empirical high PEEP-FiO₂ strategy on death and days free from mechanical ventilation among patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA, 2019, 321(9): 846-857.
4.	Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med, 2015, 372(8): 747-755.
5.	Chen L, Del Sorbo L, Grieco DL, et al. Potential for lung recruitment estimated by the recruitment-to-inflation ratio in acute respiratory distress syndrome. A Clinical trial. Am J Respir Crit Care Med, 2020, 201(2): 178-187.
6.	Talmor D, Sarge T, Malhotra A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med, 2008, 359(20): 2095-2104.
7.	Cressoni M, Cadringher P, Chiurazzi C, et al. Lung inhomogeneity in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med, 2014, 189(2): 149-158.
8.	Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest, 2008, 134(1): 117-125.
9.	Soldati G, Inchingolo R, Smargiassi A, et al. Ex vivo lung sonography: morphologic-ultrasound relationship. Ultrasound Med Biol, 2012, 38(7): 1169-1179.
10.	Mongodi S, Chiumello D, Mojoli F. Lung ultrasound score for the assessment of lung aeration in ARDS patients: comparison of two approaches. Ultrasound Int Open, 2024, 10: a24218709.
11.	Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med, 2012, 38(4): 577-591.
12.	Brower RG, Matthay MA, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-8.
13.	賴添順, 郭振輝, 蔡紹曦, 等. 不同潮氣量聯合呼氣末正壓機械通氣對急性肺損傷犬肺的影響. 中國呼吸與危重監護雜志, 2009, 8(1): 43-47.
14.	Borges JB, Okamoto VN, Matos GF, et al. Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome. Am J Respir Crit Care Med, 2006, 174(3): 268-278.
15.	Silva PL, Ball L, Rocco PRM, et al. Power to mechanical power to minimize ventilator-induced lung injury?. Intensive Care Med Exp, 2019, 7(Suppl 1): 38.
16.	Cavalcanti AB, Suzumura éA, Laranjeira LN, 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. JAMA, 2017, 318(14): 1335-1345.
17.	Gattinoni L, Pesenti A. The concept of "baby lung". Intensive Care Med, 2005, 31(6): 776-784.
18.	Terragni PP, Rosboch G, Tealdi A, et al. Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med, 2007, 175(2): 160-166.
19.	Talmor D, Sarge T, O'donnell CR, et al. Esophageal and transpulmonary pressures in acute respiratory failure. Crit Care Med, 2006, 34(5): 1389-94.
20.	Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
21.	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. Lancet Respir Med, 2016, 4(4): 272-280.
22.	Protti A, Andreis DT, Monti M, et al. Lung stress and strain during mechanical ventilation: any difference between statics and dynamics? Crit Care Med, 2013, 41(4): 1046-1055.
23.	Gattinoni L, Coppola S, Cressoni M, et al. COVID-19 does not lead to a "typical" acute respiratory distress syndrome. Am J Respir Crit Care Med, 2020, 201(10): 1299-1300.
24.	Grasselli G, Tonetti T, Protti A, et al. Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. Lancet Respir Med, 2020, 8(12): 1201-1208.
25.	Grieco DL, Bongiovanni F, Chen L, et al. Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies. Crit Care, 2020, 24(1): 529.
26.	Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care, 2014, 4(1): 1.
27.	Volpicelli G, Mussa A, Garofalo G, et al. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med, 2006, 24(6): 689-696.
28.	Reissig A, Copetti R, Kroegel C. Current role of emergency ultrasound of the chest. Crit Care Med, 2011, 39(4): 839-845.
29.	Bouhemad B, Liu ZH, Arbelot C, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med, 2010, 38(1): 84-92.
30.	張斌, 吳秀, 曹薇, 等. 肺部超聲評分在呼吸重癥疾病中的應用. 中國呼吸與危重監護雜志, 2019, 18(1): 93-97.
31.	Chiumello D, Mongodi S, Algieri I, et al. Assessment of lung aeration and recruitment by CT scan and ultrasound in acute respiratory distress syndrome patients. Crit Care Med, 2018, 46(11): 1761-1768.
32.	Mayo PH, Copetti R, Feller-Kopman D, et al. Thoracic ultrasonography: a narrative review. Intensive Care Med, 2019, 45(9): 1200-1211.
33.	Volpicelli G, Lamorte A, Tullio M, et al. Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department. Intensive Care Med, 2013, 39(7): 1290-1298.
34.	Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest, 2015, 147(6): 1659-1670.
35.	Nazerian P, Volpicelli G, Gigli C, et al. Diagnostic performance of wells score combined with point-of-care lung and venous ultrasound in suspected pulmonary embolism. Acad Emerg Med, 2017, 24(3): 270-280.
36.	Tonelotto B, Pereira SM, Tucci MR, et al. Intraoperative pulmonary hyperdistention estimated by transthoracic lung ultrasound: a pilot study. Anaesth Crit Care Pain Med, 2020, 39(6): 825-831.
37.	Nair PR, Ramachandran R, Trikha A, et al. Effect of positive end expiratory pressure on atelectasis in patients undergoing major upper abdominal surgery under general anaesthesia: A lung ultrasonography study. J Perioper Pract, 2023, 33(4): 99-106.
38.	Luo LF, Lin YM, Liu Y, et al. Effect of individualized PEEP titration by ultrasonography on perioperative pulmonary protection and postoperative cognitive function in patients with chronic obstructive pulmonary disease. BMC Pulm Med, 2023, 23(1): 232.
39.	崔玉凝. 肺部超聲引導下個體化PEEP在超重以及肥胖患者腹腔鏡手術中的應用研究[D], 2024.
40.	朱琛, 仇一然, 王丹陽, 等. 超聲引導下肺復張對胸腔鏡肺葉切除術后肺不張的影響. 臨床麻醉學雜志, 2025, 41(06): 590-594.
41.	Smit MR, Mayo PH, Mongodi S. Lung ultrasound for diagnosis and management of ARDS. Intensive Care Med, 2024, 50(7): 1143-1145.
42.	Chiumello D, Carlesso E, Cadringher P, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med, 2008, 178(4): 346-355.
43.	Sinnige JS, Smit MR, Ghose A, et al. Personalized mechanical ventilation guided by ultrasound in patients with acute respiratory distress syndrome (PEGASUS): study protocol for an international randomized clinical trial. Trials, 2024, 25(1): 308.
44.	Marini JJ, Gattinoni L. Management of COVID-19 respiratory distress. JAMA, 2020, 323(22): 2329-2330.
45.	Bos LDJ, Artigas A, Constantin JM, et al. Precision medicine in acute respiratory distress syndrome: workshop report and recommendations for future research. Eur Respir Rev, 2021, 30(159).
46.	施伶俐, 趙龍德, 張莉, 等. 肺動態順應性指導個體化PEEP滴定對顱面重建術患兒術后肺不張的影響. 臨床麻醉學雜志, 2024, 40(7): 683-687.
47.	Gattinoni L, Chiumello D, Caironi P, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med, 2020, 46(6): 1099-1102.
48.	De Jong A, Molinari N, Sebbane M, et al. Feasibility and effectiveness of prone position in morbidly obese patients with ARDS: a case-control clinical study. Chest, 2013, 143(6): 1554-1561.
49.	Via G, Storti E, Gulati G, et al. Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool. Minerva Anestesiol, 2012, 78(11): 1282-1296.
50.	Song IK, Kim EH, Lee JH, et al. Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia-induced atelectasis in infants: a randomised, controlled trial. Anaesthesia, 2017, 72(2): 214-222.

1. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med, 2013, 369(22): 2126-2136.
2. Fan E, Del Sorbo L, Goligher EC, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med, 2017, 195(9): 1253-1263.
3. Beitler JR, Sarge T, Banner-Goodspeed VM, et al. Effect of titrating positive end-expiratory pressure (PEEP) with an esophageal pressure-guided strategy vs an empirical high PEEP-FiO₂ strategy on death and days free from mechanical ventilation among patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA, 2019, 321(9): 846-857.
4. Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med, 2015, 372(8): 747-755.
5. Chen L, Del Sorbo L, Grieco DL, et al. Potential for lung recruitment estimated by the recruitment-to-inflation ratio in acute respiratory distress syndrome. A Clinical trial. Am J Respir Crit Care Med, 2020, 201(2): 178-187.
6. Talmor D, Sarge T, Malhotra A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med, 2008, 359(20): 2095-2104.
7. Cressoni M, Cadringher P, Chiurazzi C, et al. Lung inhomogeneity in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med, 2014, 189(2): 149-158.
8. Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest, 2008, 134(1): 117-125.
9. Soldati G, Inchingolo R, Smargiassi A, et al. Ex vivo lung sonography: morphologic-ultrasound relationship. Ultrasound Med Biol, 2012, 38(7): 1169-1179.
10. Mongodi S, Chiumello D, Mojoli F. Lung ultrasound score for the assessment of lung aeration in ARDS patients: comparison of two approaches. Ultrasound Int Open, 2024, 10: a24218709.
11. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med, 2012, 38(4): 577-591.
12. Brower RG, Matthay MA, Morris A, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342(18): 1301-8.
13. 賴添順, 郭振輝, 蔡紹曦, 等. 不同潮氣量聯合呼氣末正壓機械通氣對急性肺損傷犬肺的影響. 中國呼吸與危重監護雜志, 2009, 8(1): 43-47.
14. Borges JB, Okamoto VN, Matos GF, et al. Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome. Am J Respir Crit Care Med, 2006, 174(3): 268-278.
15. Silva PL, Ball L, Rocco PRM, et al. Power to mechanical power to minimize ventilator-induced lung injury?. Intensive Care Med Exp, 2019, 7(Suppl 1): 38.
16. Cavalcanti AB, Suzumura éA, Laranjeira LN, 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. JAMA, 2017, 318(14): 1335-1345.
17. Gattinoni L, Pesenti A. The concept of "baby lung". Intensive Care Med, 2005, 31(6): 776-784.
18. Terragni PP, Rosboch G, Tealdi A, et al. Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med, 2007, 175(2): 160-166.
19. Talmor D, Sarge T, O'donnell CR, et al. Esophageal and transpulmonary pressures in acute respiratory failure. Crit Care Med, 2006, 34(5): 1389-94.
20. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
21. 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. Lancet Respir Med, 2016, 4(4): 272-280.
22. Protti A, Andreis DT, Monti M, et al. Lung stress and strain during mechanical ventilation: any difference between statics and dynamics? Crit Care Med, 2013, 41(4): 1046-1055.
23. Gattinoni L, Coppola S, Cressoni M, et al. COVID-19 does not lead to a "typical" acute respiratory distress syndrome. Am J Respir Crit Care Med, 2020, 201(10): 1299-1300.
24. Grasselli G, Tonetti T, Protti A, et al. Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. Lancet Respir Med, 2020, 8(12): 1201-1208.
25. Grieco DL, Bongiovanni F, Chen L, et al. Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies. Crit Care, 2020, 24(1): 529.
26. Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care, 2014, 4(1): 1.
27. Volpicelli G, Mussa A, Garofalo G, et al. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med, 2006, 24(6): 689-696.
28. Reissig A, Copetti R, Kroegel C. Current role of emergency ultrasound of the chest. Crit Care Med, 2011, 39(4): 839-845.
29. Bouhemad B, Liu ZH, Arbelot C, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia. Crit Care Med, 2010, 38(1): 84-92.
30. 張斌, 吳秀, 曹薇, 等. 肺部超聲評分在呼吸重癥疾病中的應用. 中國呼吸與危重監護雜志, 2019, 18(1): 93-97.
31. Chiumello D, Mongodi S, Algieri I, et al. Assessment of lung aeration and recruitment by CT scan and ultrasound in acute respiratory distress syndrome patients. Crit Care Med, 2018, 46(11): 1761-1768.
32. Mayo PH, Copetti R, Feller-Kopman D, et al. Thoracic ultrasonography: a narrative review. Intensive Care Med, 2019, 45(9): 1200-1211.
33. Volpicelli G, Lamorte A, Tullio M, et al. Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department. Intensive Care Med, 2013, 39(7): 1290-1298.
34. Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest, 2015, 147(6): 1659-1670.
35. Nazerian P, Volpicelli G, Gigli C, et al. Diagnostic performance of wells score combined with point-of-care lung and venous ultrasound in suspected pulmonary embolism. Acad Emerg Med, 2017, 24(3): 270-280.
36. Tonelotto B, Pereira SM, Tucci MR, et al. Intraoperative pulmonary hyperdistention estimated by transthoracic lung ultrasound: a pilot study. Anaesth Crit Care Pain Med, 2020, 39(6): 825-831.
37. Nair PR, Ramachandran R, Trikha A, et al. Effect of positive end expiratory pressure on atelectasis in patients undergoing major upper abdominal surgery under general anaesthesia: A lung ultrasonography study. J Perioper Pract, 2023, 33(4): 99-106.
38. Luo LF, Lin YM, Liu Y, et al. Effect of individualized PEEP titration by ultrasonography on perioperative pulmonary protection and postoperative cognitive function in patients with chronic obstructive pulmonary disease. BMC Pulm Med, 2023, 23(1): 232.
39. 崔玉凝. 肺部超聲引導下個體化PEEP在超重以及肥胖患者腹腔鏡手術中的應用研究[D], 2024.
40. 朱琛, 仇一然, 王丹陽, 等. 超聲引導下肺復張對胸腔鏡肺葉切除術后肺不張的影響. 臨床麻醉學雜志, 2025, 41(06): 590-594.
41. Smit MR, Mayo PH, Mongodi S. Lung ultrasound for diagnosis and management of ARDS. Intensive Care Med, 2024, 50(7): 1143-1145.
42. Chiumello D, Carlesso E, Cadringher P, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med, 2008, 178(4): 346-355.
43. Sinnige JS, Smit MR, Ghose A, et al. Personalized mechanical ventilation guided by ultrasound in patients with acute respiratory distress syndrome (PEGASUS): study protocol for an international randomized clinical trial. Trials, 2024, 25(1): 308.
44. Marini JJ, Gattinoni L. Management of COVID-19 respiratory distress. JAMA, 2020, 323(22): 2329-2330.
45. Bos LDJ, Artigas A, Constantin JM, et al. Precision medicine in acute respiratory distress syndrome: workshop report and recommendations for future research. Eur Respir Rev, 2021, 30(159).
46. 施伶俐, 趙龍德, 張莉, 等. 肺動態順應性指導個體化PEEP滴定對顱面重建術患兒術后肺不張的影響. 臨床麻醉學雜志, 2024, 40(7): 683-687.
47. Gattinoni L, Chiumello D, Caironi P, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med, 2020, 46(6): 1099-1102.
48. De Jong A, Molinari N, Sebbane M, et al. Feasibility and effectiveness of prone position in morbidly obese patients with ARDS: a case-control clinical study. Chest, 2013, 143(6): 1554-1561.
49. Via G, Storti E, Gulati G, et al. Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool. Minerva Anestesiol, 2012, 78(11): 1282-1296.
50. Song IK, Kim EH, Lee JH, et al. Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia-induced atelectasis in infants: a randomised, controlled trial. Anaesthesia, 2017, 72(2): 214-222.

Previous Article
原發性肺滑膜肉瘤61例病例分析
Next Article
慢性阻塞性肺疾病合并肌少癥的診斷及治療進展

Chinese Journal of Respiratory and Critical Care Medicine

肺動態順應性與超聲聯合滴定PEEP策略

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content