呼吸機(jī)治療的肺保護(hù)策略(已修改)
2024-10-31 13:28 本頁(yè)面
【正文】 呼吸機(jī)治療的肺保護(hù)策略 浙江大學(xué)醫(yī)學(xué)院附屬兒童醫(yī)院 施麗萍 呼吸機(jī)相關(guān)性肺損傷 ? acute parenchymal lung injury and an acute inflammatory response in the lung. ? cytokines →alveoli and the systemic circulation →multiple an dysfunction ? mortality↑ 呼吸機(jī)相關(guān)性肺損傷 ventilatorinduced lung injury ? 容量性損傷 Volutrauma（ large gas volumes ） ? 壓力性損傷 Barotrauma（ high airway pressure ） ? 不張性損傷 Atelectotrauma（ alveolar collapse and reexpansion） ? 生物性損傷 Biotrauma（ increased inflammation ） 肺 損 傷 病 理 ? alveolar structural damage ? pulmonary edema、 inflammation、 fibrosis ? surfactant dysfunction ? other an dysfunction ? exacerbate the disturbance of lung development Semin Neonatol. 2021 Oct。7(5):35360. Approaches in the management of acute respiratory failure in children protective ventilatory and potential protective ventilatory modes lower tidal volume and PEEP permissive hypercapnia highfrequency oscillatory ventilation airway pressure release ventilation partial liquid ventilation improve oxygenation recruitment maneuvers prone positioning kiic therapy reduce FiO2 and facilitate gas exchange inhaled nitric oxide and surfactant Curr Opin Pediatr. 2021 Jun。16(3):2938. Can mechanical ventilation strategies reduce chronic lung disease? ? continuous positive airway pressure ? permissive hypercapnia ? patienttriggered ventilation ? volumetargeted ventilation ? proportional assist ventilation ? highfrequency ventilation Semin Neonatol. 2021 Dec。8(6):4418 小潮氣量和呼氣末正壓 lower tidal volume and PEEP Ventilation with lower tidal volumes versus traditional tidal volumes in adults for ALI and ARDS ? 1202 patients ? lower tidal volume (≤7ml/kg) low plateau pressure ≤30 cm H2O versus ? tidal volume 10 to 15 ml/kg ? Mortality at day 28 ? ? longterm mortality was uncertain ? low and conventional tidal volume with plateau pressure ≤31 cm H2O was not significantly different Cochrane Database Syst Rev. 2021。(2):CD003844 Higher versus lower positive endexpiratory pressures in patients with the acute respiratory distress syndrome ? 549 patients acute lung injury and ARDS ? lowerPEEP group 177。 higherPEEP group 177。 (P). ? tidalvolume 6ml/kg endinspiratory plateaupressure≤30cmH2O ? The rates of death % % (p=) From day 1 to day 28, breathing was unassisted 177。 days 177。 days (p=) ? clinical outes are similar whether lower or higher PEEP levels are used. N Engl J Med.
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