如何优化心跳骤停后呼吸机设置？

第一条：潮气量应该是保护性的

We suggest that in post-CA patients the VT should be set between 6 and 8 mL/kg PBW, in volume- or pressure-controlled ventilation but keeping in mind the interplay between VT and other parameters of MV (i.e., Pplat, ΔP, PEEP, MP) as well as hemodynamics. Assisted ventilation may be used according to clinical conditions and the level of sedation of the patient.

作者团队建议在心跳骤停（CA）后，无论是容量还是压力控制通气，病人的潮气量（VT）应该设置在6-8ml/kg理想体重，但切记VT与其他机械通气（MV）参数间的相互影响，例如平台压（Pplat）、驱动压（ΔP）、呼气末正压（PEEP）、机械能（MP），以及血流动力学。依据临床情况与病人的镇静程度，或可使用辅助通气模式。

第二条：平台压应该个体化

We suggest that in post-CA patients the Pplat should be kept equal or lower than 20 cmH2O and corrected for intra-abdominal pressure when clinically indicated. In obese patients or those with increased intra-abdominal pressure with Pplat>27 cmH2O, a simplified formula may help estimate the required correction of Pplat: Pplat target+(intra-abdominal pressure-13cmH2O)/2.

作者团队建议CA后病人的平台压应该小于或等于20cmH2O；当有临床指征，需要根据腹内压进行校正。对于肥胖或那些腹内压增加而平台压大于27cmH2O的病人，一条简易的公式或有助于估计平台压所需的校正：目标平台压+(腹内压-13cmH2O)/2。

第三条：呼气末正压要低一些，但必须足够

We suggest that in post-CA patients a PEEP of 5 cmH2O should be initially used to reach a SatO2 at least above 92% and progressively increase in case of oxygen desaturation or worsening of respiratory mechanics.

作者团队建议CA后就开始使用5cmH2O的PEEP使血氧饱和度（SatO2）至少在92%以上，如果SatO2下降，或呼吸力学恶化，可以逐渐增加。

第四条：关注驱动压！

We suggest in post-CA patients to maintain a ΔP<13cmH2O optimizing the VT for the respective compliance of the respiratory system.

作者团队建议CA后根据呼吸系统的顺应性优化设置潮气量，以维持ΔP<13cmH2O。

第五条：应以动脉pH值（pHa）与二氧化碳分压（PaCO2）为目标调整呼吸频率

We suggest that in post-CA patients, the respiratory rate should be kept in a range between 8 and 16 breaths/min.

作者团队建议CA后，病人的呼吸频率应保持在8~16次/分的范围之内。

第六条：机械能是个引人注目的指标，但应谨慎

As per evidence to date, if assessed at the bedside, we suggest that in post-CA patients MP should be targeted as lower than 17 J/min, taking into account ΔP and respiratory rate.

按目前的证据，如果可以床旁评估，作者团队建议在CA后，机械能应以<17焦/分钟为目标，但要考虑到ΔP与呼吸频率。

第七条：氧合必须精确地调整到正常范围

According to the findings to date, a cutoff of PaO2 of 70–110mmHg seems reasonable in this patient population.

根据目前的发现，这类病人的PaO2的切点值设定在70~110mmHg看来是合理的。

第八条：目前来说，PaCO2应在正常范围

The appropriate threshold to apply in post-CA patients is yet to be defined. According to the literature, a value of PaCO2 ranging between 35 and 50 mmHg seems to be preferable.

尚未确定适用于CA患者的合适的PaCO2阈值。根据文献，35~50mmHg范围内的数值看来是可取的。

第九条：体温也可以影响通气功能

In patients who remain comatose post-CA, the guidelines recommend continuous monitoring of core temperature and prevention of fever (defined as a temperature>37.7 °C) for at least 72 h. Evidence is insufficient to recommend for or against temperature control at 32–36 °C or early cooling after CA.

对于CA后仍然昏迷的病人，指南推荐至少72小时连续监测核心体温并防止发热（定义为体温>37.7°C）。没有充足的证据支持或反对体温控制在32~36°C和CA后早期降温。

第十条：血流动力学必须维持稳定

Patients with post-CA syndrome need to be strictly monitored for possible detrimental respiratory and cardiovascular interactions, thus accounting for targeted temperature management (around 36°C) and personalized cardiovascular targets.

CA后综合征的病人可能出现呼吸系统与心血管系统的有害互动，必须严密监测，以应对目标体温管理（36°C左右）和个体化的心血管系统目标。

出处：急重症世界