3．人工呼吸器

Respirator in New Technology for Respiratory Medicine

医療機器の進歩に伴い，人工呼吸器の機能の向上，操作の簡素化，患者への負担軽減がすすんでいる．特に，これまで問題となっていた人工呼吸器による肺損傷（ventilator associated lung in­jury：VALI）を引き起こさないようにする肺保護（lung protective strategy）を重視した呼吸管理を，新しいテクノロジーや考え方を用いて行うようになってきている．本稿では肺保護の観点から，人工呼吸器の新しい考え方を紹介する．

According to the progress in medical devices, respirators are improving to avoid ventilator-associated lung injury with new technology and concepts. At first, we need to know the methods of respirator settings；they are the respiratory mode and method. Respiratory modes are assist/control （A/C）, synchronized intermittent mandatory ventilation （SIMV）, and continuous positive airway pressure （CPAP）. The respiratory methods are volume-controlled ventilation （VCV）, pressure-controlled ventilation （PCV）, and pressure support ventilation （PSV）. The new methods of ventilation are airway pressure release ventilation （APRV） and neurally adjusted ventilatory assist （NAVA）. To protect the lung injury by ventilation, we need to control the limitation of ventilation volume in one breath, high positive end-expiratory pressure, plateau pressure in lung alveoli, auto positive end-expiratory pressure, and driving pressure in respiration. Coming to the new devices, lung injury would be mitigated by mechanical ventilation.