烧伤相关肺损伤的呼吸治疗任重道远

朱峰; 郭光华

doi:10.3760/cma.j.cn501225-20240802-00291

烧伤相关肺损伤的呼吸治疗任重道远

doi: 10.3760/cma.j.cn501225-20240802-00291

朱峰^1, ,,
郭光华²

1.
同济大学附属东方医院重症医学科,上海　200120
2.
南昌大学第一附属医院烧伤整形与创面修复医学中心,南昌　330006

基金项目:

国家重点研发计划 2019YFA0110601

详细信息

通讯作者:
朱峰,Email：alexzhufeng0816@vip.sina.com

计量
- 文章访问数: 29
- HTML全文浏览量: 6
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-08-02

Respiratory care for burn-related lung injury--shoulder heavy responsibilities, and a long way to go

Zhu Feng^{1
, ,},
Guo Guanghua²

1.
Department of Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai200120, China
2.
Medical Center of Burn Plastic and Wound Repair, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang330006, China

Funds:

National Key Research and Development Program 2019YFA0110601

More Information

Corresponding author: Zhu Feng, Email: alexzhufeng0816@vip.sina.com

摘要

摘要: 烧伤后常伴有呼吸道损伤和肺损伤,严重影响该类患者的预后与治疗效果。呼吸治疗指在专业医师指导、协作下,对心肺功能不全或异常患者给予预防、评价、诊断、治疗、管理和照顾,是急性呼吸窘迫综合征治疗中的重要组成部分,也逐步应用于烧伤相关肺损伤。呼吸治疗涵盖了疾病的防与治,与烧伤创面修复、整体康复互作,需要从业者更多地关注、研究和实践。该文在国内外呼吸治疗技术快速发展和烧伤相关肺损伤研究与实践相对有限的背景下,试图从多层面阐述和分析实施烧伤相关肺损伤呼吸治疗的意义、具体措施和不足之处,旨在鼓励更多从业者深入学习和参与,通过积累和总结,达到科学、规范实施烧伤相关肺损伤呼吸治疗的目的。
- 烧伤,吸入性 /
- 肺损伤 /
- 呼吸治疗
Abstract: Burns is often accompanied by respiratory tract and lung injuries, which seriously affects the prognosis and treatment effect of such patients. Respiratory care refers to the prevention, evaluation, diagnosis, treatment, management, and care of patients with cardiopulmonary insufficiency or abnormalities under the guidance and cooperation of professional doctors, which is an important part of acute respiratory distress syndrome treatment and is also gradually applied in burn-related lung injuries. Respiratory care covers prevention and treatment, and interacts with burn wound repair and overall rehabilitation, which requires more attention, research, and practice from practitioners. Under the background of the rapid development of respiratory care and the relatively limited burn-related lung injury research and practice, this paper tries to elaborate and analyze the significance of respiratory care for burn-related lung injury, specific measures, and shortcomings, aiming to encourage more practitioners to study and participate in depth, and through accumulation and summary, to achieve the purpose of scientific and standardized implementation of respiratory care for burn-related lung injury.
- Burns, inhalation /
- Lung injury /
- Respiratory care
所有作者均声明不存在利益冲突

HTML全文

参考文献(42)

[1]	World Health OrganizationBurns2023-10-132024-08-02https://www.who.int/en/news-room/fact-sheets/detail/burns World Health Organization. Burns[EB/OL].(2023-10-13)[2024-08-02]. https://www.who.int/en/news-room/fact-sheets/detail/burns.
[2]	RehbergS, MaybauerMO, EnkhbaatarP, et al. Pathophysiology, management and treatment of smoke inhalation injury[J]. Expert Rev Respir Med, 2009,3(3):283-297. DOI: 10.1586/ERS.09.21.
[3]	GormanEA, O'KaneCM, McAuleyDF. Acute respiratory distress syndrome in adults: diagnosis, outcomes, long-term sequelae, and management[J]. Lancet, 2022,400(10358):1157-1170. DOI: 10.1016/S0140-6736(22)01439-8.
[4]	American Association for Respiratory CareStatement of definition of respiratory care2017-032024-10-24https://www.aarc.org/wp-content/uploads/2017/03/statement-of-definition-of-respiratory-care.pdf American Association for Respiratory Care. Statement of definition of respiratory care[EB/OL]. (2017-03)[2024-10-24]. https://www.aarc.org/wp-content/uploads/2017/03/statement-of-definition-of-respiratory-care.pdf.
[5]	HiserJ. We are on Mission[J]. AARC Times,2010,34:39-42.
[6]	梁国鹏, 杨福, 康焰, 等. 中国呼吸治疗的现状与发展[J].中国呼吸与危重监护杂志,2020,19(6):533-535. DOI: 10.7507/1671-6205.202010058.
[7]	LiJ. Expanding the RT group in mainland China[J]. AARC Times,2010,34:48-49.
[8]	American Association for Respiratory CareAARC respiratory therapist human resource study 20142024-10-24https://archive2023.aarc.org/resources/tools‐software/aarc-respiratory-therapist-human-resource-study-2014/ American Association for Respiratory Care. AARC respiratory therapist human resource study 2014[EB/OL]. 2014[2024-10-24].https://archive2023.aarc.org/resources/tools‐software/aarc-respiratory-therapist-human-resource-study-2014/.
[9]	HuangS, MiaoY, WangY, et al. A bibliometric analysis of the trends and evolution on inhalation injury research[J]. J Burn Care Res, 2024,45(2):438-450. DOI: 10.1093/jbcr/irad172.
[10]	HolleyAD, ReadeMC, LipmanJ, et al. There is no fire without smoke! Pathophysiology and treatment of inhalational injury in burns: a narrative review[J]. Anaesth Intensive Care, 2020,48(2):114-122. DOI: 10.1177/0310057X20913282.
[11]	MatthayMA, ArabiY, ArroligaAC, et al. A new global definition of acute respiratory distress syndrome[J]. Am J Respir Crit Care Med, 2024,209(1):37-47. DOI: 10.1164/rccm.202303-0558WS.
[12]	中国老年医学学会烧创伤分会. 吸入性损伤临床诊疗全国专家共识(2018版)[J].中华烧伤杂志,2018,34(11):770-775. DOI: 10.3760/cma.j.issn.1009-2587.2018.11.010.
[13]	Milton-JonesH, SoussiS, DaviesR, et al. An international RAND/UCLA expert panel to determine the optimal diagnosis and management of burn inhalation injury[J]. Crit Care, 2023,27(1):459. DOI: 10.1186/s13054-023-04718-w.
[14]	GaverDP3rd, NiemanGF, GattoLA, et al. The POOR get POORer: a hypothesis for the pathogenesis of ventilator-induced lung injury[J]. Am J Respir Crit Care Med, 2020,202(8):1081-1087. DOI: 10.1164/rccm.202002-0453CP.
[15]	MariniJJ, RoccoP, GattinoniL. Static and dynamic contributors to ventilator-induced lung injury in clinical practice. Pressure, energy, and power[J]. Am J Respir Crit Care Med, 2020,201(7):767-774. DOI: 10.1164/rccm.201908-1545CI.
[16]	刘晓彬, 朱峰. 从机械能视角再理解呼吸机相关性肺损伤[J].中华烧伤杂志,2021,37(3):292-295. DOI: 10.3760/cma.j.cn501120-20200203-00039.
[17]	张瑞, 何怀武, 隆云. 呼吸机相关性肺血管损伤的研究进展[J/OL].中华重症医学电子杂志,2020,6(1):100-103[2024-08-02]. https://d.wanfangdata.com.cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjQwNzA0Ehd6aHp6eXhkenp6LXdsYjIwMjAwMTAzMBoIYWJqOHN0b2w%3D. DOI: 10.3877/cma.j.issn.2096-1537.2020.030.
[18]	HamahataN, PinskyMR. Heart-lung interactions[J]. Semin Respir Crit Care Med, 2023,44(5):650-660. DOI: 10.1055/s-0043-1770062.
[19]	CarteauxG, ParfaitM, CombetM, et al. Patient-self inflicted lung injury: a practical review[J]. J Clin Med, 2021, 10(12): 2738. DOI: 10.3390/jcm10122738.
[20]	任志国, 朱峰. 自戕性肺损伤的机制和防治研究进展[J].中华烧伤杂志,2021,37(8):801-804. DOI: 10.3760/cma.j.cn501120-20200610-00302.
[21]	ParkPK, NapolitanoLM. Modern mechanical ventilation strategies for the acute care surgeon: what you need to know[J]. J Trauma Acute Care Surg, 2024,96(4):523-536. DOI: 10.1097/TA.0000000000004194.
[22]	KlompasM, BransonR, CawcuttK, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update[J]. Infect Control Hosp Epidemiol, 2022,43(6):687-713. DOI: 10.1017/ice.2022.88.
[23]	AlnimrA. Antimicrobial resistance in ventilator-associated pneumonia: predictive microbiology and evidence-based therapy[J]. Infect Dis Ther, 2023,12(6):1527-1552. DOI: 10.1007/s40121-023-00820-2.
[24]	TiseoG, GalfoV, FalconeM. What is the clinical significance of "heteroresistance" in nonfermenting Gram-negative strains?[J]. Curr Opin Infect Dis, 2023,36(6):555-563. DOI: 10.1097/QCO.0000000000000964.
[25]	中国病理生理危重病学会呼吸治疗学组. 重症患者气道廓清技术专家共识[J/OL].中华重症医学电子杂志,2020,6(3):272-282[2024-08-02]. https://d.wanfangdata.com.cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjQwNzA0Ehd6aHp6eXhkenp6LXdsYjIwMjAwMzAwNxoIZjkxbmVvdzE%3D. DOI: 10.3877/cma.j.issn.2096-1537.2020.03.007.
[26]	张宇翔, 兰美娟, 梁诗雨, 等. 物理性气道廓清技术在吸入性损伤治疗中的应用进展[J].中华烧伤与创面修复杂志,2023,39(5):475-480. DOI: 10.3760/cma.j.cn501225-20220608-00226.
[27]	中国老年医学学会烧创伤分会, 中华医学会烧伤外科学分会重症学组. 成人烧伤俯卧位治疗全国专家共识(2022版)[J].中华烧伤与创面修复杂志,2022,38(7):601-609. DOI: 10.3760/cma.j.cn501120-20211208-00407.
[28]	LiJ, LiuK, LyuS, et al. Aerosol therapy in adult critically ill patients: a consensus statement regarding aerosol administration strategies during various modes of respiratory support[J]. Ann Intensive Care, 2023,13(1):63. DOI: 10.1186/s13613-023-01147-4.
[29]	中国老年医学会呼吸病学分会, 中国康复医疗机构联盟呼吸康复专业委员会. 吸入疗法在呼吸康复中应用的中国专家共识[J].中华结核和呼吸杂志,2022,45(8):753-761. DOI: 10.3760/cma.j.cn112147-20220119-00060.
[30]	中国医药教育协会感染疾病专业委员会, 中华结核和呼吸杂志编辑委员会, 中国药学会药物临床评价研究专业委员会. 抗菌药物超说明书用法专家共识[J]. 中华结核和呼吸杂志, 2015, 38(6): 410-444. DOI: 10.3760/cma.j.issn.1001-0939.2015.06.005.
[31]	王玉松, 马琪敏, 朱峰, 等. 间充质干细胞及其衍生物雾化吸入治疗肺部疾病研究进展[J].中华危重病急救医学,2022,34(8):881-885. DOI: 10.3760/cma.j.cn121430-20220706-00636.
[32]	GattinoniL, TacconeP, CarlessoE, et al. Prone position in acute respiratory distress syndrome. Rationale, indications, and limits[J]. Am J Respir Crit Care Med, 2013,188(11):1286-1293. DOI: 10.1164/rccm.201308-1532CI.
[33]	AlhazzaniW, ParharK, WeatheraldJ, et al. Effect of awake prone positioning on endotracheal intubation in patients with COVID-19 and acute respiratory failure: a randomized clinical trial[J]. JAMA, 2022,327(21):2104-2113. DOI: 10.1001/jama.2022.7993.
[34]	GuérinC, ReignierJ, RichardJC, et al. Prone positioning in severe acute respiratory distress syndrome[J]. N Engl J Med, 2013,368(23):2159-2168. DOI: 10.1056/NEJMoa1214103.
[35]	MyatraSN, AlhazzaniW, Belley-CoteE, et al. Awake proning in patients with COVID-19-related hypoxemic acute respiratory failure: a rapid practice guideline[J]. Acta Anaesthesiol Scand, 2023,67(5):569-575. DOI: 10.1111/aas.14205.
[36]	SchmidtM, HajageD, LebretonG, et al. Prone positioning during extracorporeal membrane oxygenation in patients with severe ARDS: the PRONECMO randomized clinical trial[J]. JAMA, 2023,330(24):2343-2353. DOI: 10.1001/jama.2023.24491.
[37]	RoldánR, RodriguezS, BarrigaF, et al. Sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated Covid-19 ARDS patients[J]. Ann Intensive Care, 2022,12(1):13. DOI: 10.1186/s13613-022-00988-9.
[38]	Community resources for rehabilitation of patients with chronic obstructive pulmonary diseases and cor pulmonale. Pulmonary Rehabilitation Study Group[J]. Circulation, 1974,49(5Suppl):S1-20.
[39]	RodriguesA, Muñoz CastroG, JácomeC, et al. Current developments and future directions in respiratory physiotherapy[J]. Eur Respir Rev, 2020,29(158):200262.DOI: 10.1183/16000617.0264-2020.
[40]	SpruitMA, RochesterCL, PittaF, et al. Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care[J]. Thorax, 2019,74(7):693-699. DOI: 10.1136/thoraxjnl-2018-212044.
[41]	TroostersT, JanssensW, DemeyerH, et al. Pulmonary rehabilitation and physical interventions[J]. Eur Respir Rev, 2023, 32(168):220222. DOI: 10.1183/16000617.0222-2022.
[42]	中华医学会灾难医学分会, 中国医师协会急救复苏与灾难医学分会, 中国医学救援协会救援防护分会. ARDS患者肺康复训练专家共识[J].中国急救复苏与灾害医学杂志,2022,17(4):421-426. DOI: 10.3969/j.issn.1673-6966.2022.04.001.