zh-cn	如何使用呼吸机为新冠肺炎重型和危重型患者提供有效的呼吸支持？ 
en-us	How to use ventilators to effectively support severe or critically severe patients? 

zh-cn	截至3月29日，全球新冠肺炎确诊病例超过66万例。
en-us	As of March 29, confirmed cases of the novel coronavirus pneumonia (NCP) have exceeded 660,000 globally. 

zh-cn	随着新冠肺炎疫情全球大流行，呼吸机在多国宣布告急。
en-us	Many countries are now facing daunting shortages of lifesaving ventilators due to the pandemic.

zh-cn	美国重症医学会（Society of Critical Care Medicine, SCCM）估计，全美96万患者或因新冠肺炎需要呼吸机支持，而美国目前仅有约20万台。
en-us	 The Society of Critical Care Medicine (SCCM) estimated that about 960,000 NCP patients would require ventilatory support in the United States, while there are only about 200,000 ventilators currently. 

zh-cn	近期，纽约市批准允许两名患者共享一台呼吸机。
en-us	New York State has approved technology that allows two patients to share a single ventilator. 

zh-cn	为应对呼吸机严重短缺的局面，各国都在努力增产、转产。
en-us	To address the desperate needs of ventilators, many countries are making great efforts to expand production. 

zh-cn	呼吸机是恢复患者的血氧饱和度、降低死亡率的重要医疗设备，在新冠肺炎重型和危重型患者的救治中意义重大。
en-us	Ventilators help restore patients’ blood oxygen saturation, thus playing a vital role in the treatment of severe and critically severe NCP patients. 

zh-cn	然而，中国诊疗经验表明，在呼吸机的使用中应注意以下几点，才能为患者提供有效的呼吸支持。 
en-us	However, China’s experience indicates that the following points should be noted in the use of ventilators. 

zh-cn	一是根据患者实际情况调整呼吸机参数并实时监测。
en-us	First, medical workers need to adjust ventilator parameters based on patients’ physical conditions. 

zh-cn	新冠肺炎死亡病例解剖研究发现，患者肺里有大量粘稠分泌物，氧气无法进入肺泡进行气体交换，输氧也无法吸收，导致患者窒息而死。
en-us	In several anatomical studies, researchers have observed a large number of sticky secretions in lungs of death cases. These secretions prevent oxygen from entering alveoli, where gas exchange occurs, thus resulting in suffocation and death. 

zh-cn	国家卫生健康委高级别专家组组长、中国工程院院士钟南山也表示，新冠肺炎重症的突出特点是小气道中黏液非常多，粘稠度很高，阻碍气道通畅。 
en-us	Zhong Nanshan, head of the high-level expert group of the National Health Commission and academician of the Chinese Academy of Sciences, pointed out that the large number of viscous mucus in the small airways of serve cases obstructed airflow. 

zh-cn	如果呼吸机压力过高，反而可能推远黏液栓，导致肺实变。
en-us	That means the mucus plug may be pushed further if the ventilator pressure is too high. 

zh-cn	这意味着，在使用呼吸机为患者提供呼吸支持时，要严格评估并实时监测患者的呼吸力学情况，据此调整参数。
en-us	Therefore, it is necessary to evaluate patients’ respiratory mechanics conditions and to adjust ventilator parameters accordingly. 

zh-cn	二是辅以适当的痰液清理手段。
en-us	Second, appropriate sputum cleansing methods should be adopted meanwhile. 

zh-cn	要让呼吸机有效发挥呼吸支持作用，必须先把肺部黏液稀释并清除掉，“打通”给氧道路。 
en-us	To enable the ventilators to effectively provide respiratory support, mucus must be diluted and removed to “open up” the airflow path. 

zh-cn	临床上应根据患者情况，化痰、吸痰、清理呼吸道，再进行给氧支持。
en-us	Practically, medical workers should provide respiratory support after helping patients with phlegm reduction, sputum suction and airway cleansing. 

zh-cn	危重型患者使用气管插管和有创呼吸机后，正常的排痰功能受到限制，应尽量采取密闭式吸痰机来清除患者大气道黏液，以防患者气道分泌物喷溅导致交叉感染；确有必要时行支气管镜检查采取相应治疗，但在此过程中，医护人员务必做好自我防护，以防感染。 
en-us	For critically severe patients using tracheal intubation and invasive mechanical ventilation, their normal sputum discharge function is limited. In such cases, closed sputum suction should be considered, and bronchoscopy should be performed when necessary. In the process, medical workers must take good self-protection to prevent infection. 

zh-cn	三是尽量帮助患者俯卧位通气。
en-us	Last but not least, prone positioning is helpful for patients in mechanical ventilation.

zh-cn	一项观察性研究发现，许多患者在高正压下反应不佳，相较之下，当病人处于俯卧位时，肺功能会得到改善。
en-us	A recent observational study conducted in a 35-bed ICU at Wuhan Jinyintan Hospital found that some patients with severe Acute Respiratory Syndrome (ARDS) did not respond well to high positive pressure, while their lung recruitability was improved in prone positioning.

zh-cn	这是因为，严重急性呼吸窘迫综合征（Acute Respiratory Distress Syndrome, ARDS）患者仰卧位时，肺底部的肺组织塌陷。
en-us	That is because tissues at the bottom of lungs collapse in supine positioning.

zh-cn	通过俯卧姿势，背部的肺底部朝上，可以利用呼吸力学原理使肺部张开，这对于改善病患氧合状态具有一定效果。
en-us	In contrast, lung tissues face upwards and lungs expand in prone positioning due to respiratory mechanics, exerting positive effects on improving patients’ oxygenation status. 

zh-cn	因此在人力资源充足的情况下，每天应当帮助严重急性呼吸窘迫综合症患者进行12小时以上的俯卧位通气。
en-us	Therefore, for patients with severe ARDS, prone ventilation should be performed for more than 12 hours per day.