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Abstract：
For patients with acute respiratory insufficiency, mechanical (\"invasive\") ventilation is a fundamental therapeutic measure to ensure sufficient gas exchange. Despite decades of strong research efforts, central questions on mechanical ventilation therapy are still answered incompletely. Therefore, many different ventilation modes and settings have been used in daily clinical practice without scientifically sound bases. At the same time, implementation of the few evidence-based therapeutic concepts (e.g., \"lung protective ventilation\") into clinical practice is still insufficient. The aim of our guideline project \"Mechanical ventilation and extracorporeal gas exchange in acute respiratory insufficiency\" was to develop an evidence-based decision aid for treating patients with and on mechanical ventilation. It covers the whole pathway of invasively ventilated patients (including indications of mechanical ventilation, ventilator settings, additional and rescue therapies, and liberation from mechanical ventilation). To assess the quality of scientific evidence and subsequently derive recommendations, we applied the Grading of Recommendations, Assessment, Development and Evaluation method. For the first time, using this globally accepted methodological standard, our guideline contains recommendations on mechanical ventilation therapy not only for acute respiratory distress syndrome patients but also for all types of acute respiratory insufficiency. This review presents the two main chapters of the guideline on choosing the mode of mechanical ventilation and setting its parameters. The guideline group aimed that - by thorough implementation of the recommendations - critical care teams may further improve the quality of care for patients suffering from acute respiratory insufficiency. By identifying relevant gaps of scientific evidence, the guideline group intended to support the development of important research projects.
摘要：
对于急性呼吸功能不全的患者，机械（“侵入性”）通气是确保充分气体交换的基本治疗措施。尽管几十年来的强大的研究努力，关于机械通气治疗的核心问题仍未得到完全回答。因此,许多不同的通气模式和设置已在日常临床实践中使用，没有科学依据。同时,实施少数基于证据的治疗概念(例如，\"肺保护性通气\")融入临床实践尚有不足。我们的指南项目“急性呼吸功能不全的机械通气和体外气体交换”的目的是开发一种基于证据的决策辅助工具，用于治疗和接受机械通气的患者。它涵盖了侵入性通气患者的整个路径（包括机械通气的适应症，呼吸机设置,额外和救援疗法，并从机械通风中解放出来)。评估科学证据的质量并随后得出建议，我们应用了建议分级，评估,开发和评价方法。第一次,使用这个全球公认的方法标准，我们的指南不仅包含急性呼吸窘迫综合征患者的机械通气治疗建议,还包含所有类型的急性呼吸功能不全患者的机械通气治疗建议.本文介绍了指南的两个主要章节，内容涉及选择机械通风方式和设置其参数。该指南小组的目标是-通过彻底实施建议-重症监护团队可以进一步提高急性呼吸功能不全患者的护理质量。通过确定科学证据的相关差距，指导小组打算支持重要研究项目的开发。
