人工呼吸は肺のみならず横隔膜を傷害し，横隔膜機能障害は不良な転帰に関係する。 人工呼吸による横隔膜傷害の機序には，①過剰な補助による低活動，②不十分な補助による過剰活動，③呼気相における奇異性収縮，④高い呼気終末陽圧の急激な減量，が挙げられる。 人工呼吸中の横隔膜傷害を予防するためには，適切なレベルの横隔膜活動を維持することが重要であり，吸気努力のモニタリングと注意深い人工呼吸器設定，患者-人工呼吸器非同調の回避がこれを可能にする。敗血症などの重症病態は横隔膜傷害を加速させるため，横隔膜保護を意識した人工呼吸戦略はICU患者の予後改善のために考慮されるべきである。本稿では，横隔膜の基礎知識，人工呼吸に関連した横隔膜機能障害の臨床エビデンスと発生機序，横隔膜保護戦略の要点を概説する。

Anaesthesia and surgery induce major changes in respiratory function, in particular when the thorax or the upper abdomen are involved. Pulmonary volumes decrease, and atelectasis can develop. Postoperative pain and diaphragm dysfunction further worsen the respiratory function, contributing to the risk of acute respiratory failure. non-invasive ventilation proved to be beneficial in the postoper...

One of the cornerstones of critical care medicine is support of the failing respiratory system. The 2 major components of managing respiratory failure are the acute intervention and the weaning process. Many of the studies to determine the optimal methods of ventilation and weaning have focused on non-invasive positive-pressure ventilation as an alternative to invasive ventilation, with various...

OBJECTIVE To evaluate the usefulness of continuous noninvasive mechanical ventilation and mechanical coughing aids to avoid endotracheal intubation and tracheostomy during episodes of acute respiratory failure in patients with neuromuscular disease. DESIGN We conducted a prospective cohort study at the respiratory medicine ward of a university hospital to study the success rate of the use of ...

Patients with chronic respiratory failure may require intensive care unit (ICU) admission to overcome severe episodes of acute-on-chronic respiratory failure with ventilatory assistance.1 However, ICUs are expensive resources.2 A high proportion of patients with acute-onchronic respiratory failure in the ICU do not require invasive ventilation and may be treated with noninvasive ventilation (NI...

Outcomes for invasive mechanical ventilation and extracorporeal membrane oxygenation (ECMO) to treat acute respiratory failure in patients with mild cystic fibrosis (CF) lung disease are not known. We present a case of the successful use of ECMO to treat acute respiratory failure secondary to staphylococcal sepsis in an adolescent CF patient with previously normal lung function. Her post-ECMO c...

PATIENT Female, 57 FINAL DIAGNOSIS: Syryngomyelia • cervical SYMPTOMS Acute respiratory insufficiency Medication: - Clinical Procedure: - Specialty: Pulmonology. OBJECTIVE Rare disease. BACKGROUND Failed planned extubation occurs in a minority of patients with acute respiratory failure requiring invasive mechanical ventilation. In patients presenting with acute respiratory failure with no...

BACKGROUND Respiratory failure in acute organophosphate (OP) poisoning can occur early and also relatively late in the clinical course, and the pathophysiology of respiratory failure at these different phases may have important clinical implications. Objective. To compare the electrophysiological findings in patients with early and late respiratory failure following acute OP poisoning. METHOD...