【正文】 epithelial cell is injured (arrows). The basement membrane is denuded (arrows) and lined with cell debris and fibrinous deposits (hyaline membranes). AS, alveolar space, ., interstitial edema。 ZEEP, 0 positive endexpiratory pressure。 正常的肺和由高 PIP/低 PEEP引起的 VILI 〔 PI標(biāo)記的損傷的肺泡細(xì)胞〕 Am J Respir Crit Care Med (38).) Figure . Confocal images of subpleural alveoli (top, control and injury). Red nuclei (propidium iodide [PI]) mark the injured cells (top, injury). Bar graph, mean number of PIpositive cells per alveolus。 Crit Care Med 2024 Vol. 33. No. 3(suppl) Figure 1. In vivo photomicrographs of the same normal (A and B) and acutely injured lung (C and D). Alveoli at peak inspiration (A) and end expiration (B) in the normal lung are very stable with little change in size during tidal ventilation (dots). High positive inspiratory pressure (PIP) and low PEEP injurious ventilation causes a ventilatorinduced lung injury resulting in alveolar instability. Injured alveoli at peak inspiration (C) are inflated (dots) and totally collapse (arrows) end expiration (D), demonstrating severe instability during tidal ventilation. 第三十三頁(yè)，共五十六頁(yè)。 ? 肺損傷 多臟器功能衰竭 第三十二頁(yè)，共五十六頁(yè)。 第三十一頁(yè)，共五十六頁(yè)。 呼吸機(jī)所致肺損傷 ? 肺萎陷傷 (atelectrauma) ? ALI 呼氣末容積過(guò)低時(shí) , 肺泡和終末氣道的周期性開閉可致 肺外表活性物質(zhì)大量損失 , 加重肺不張和肺水腫。 ? 容積傷的形成主要與過(guò)大的吸氣末肺容積對(duì)肺泡上皮和血管內(nèi)皮的過(guò)度牽拉 (overstretch) 有關(guān)。 High Peak Airway Pressure is Bad. 8 cm H2O for 20 min 30 cm H2O for 20 min 第二十九頁(yè)，共五十六頁(yè)。 ? 氣體進(jìn)入肺循環(huán)那么引起氣體栓塞。 ? 假設(shè)臟層胸膜破裂 , 氣體可進(jìn)入胸腔。 呼吸機(jī)所致肺損傷 ? 肺氣壓傷 (barotrauma) ? 由于氣道壓過(guò)高導(dǎo)致的張力性氣胸 , 肺間質(zhì) , 縱隔和皮下氣腫 , 心包和腹膜后積氣 , 氣腹 , 系統(tǒng)性氣體栓塞 (統(tǒng)稱為肺泡外氣體 ) 。主要有肺氣壓傷、肺容積傷、肺萎陷傷、肺生物傷所致。 BIPAP Was Responsible For A 43% Reduction In Sedation T H E E F F E C T O F B I L E V E L M O D E O N O P I O I D U T I L I Z A T I O N I N AM E D I C A L I N T E N S I V E C A R E U N I T J o h n S a u l R R T , K e n H a r g e t t R R T , L i s a W e a v i n d M D , A n d r e w S h a w M D ,M e c h e l l e W i l l i a m s R N A N P C S , S u s a n n a h K i s h R N C S C C R N C P A NT h e U n i v e r s i t y o f T e x a s M D A n d e r s o n C a n c e r C e n t e r , H o u s t o n , T e x a sI n t r o d u c t i o n : T h e u s e o f a n a l g e s i a o n m e c h a n i c a l l y v e n t i l a t e d p a t i e n t s i s ac o m m o n p r a c t i c e i n t h e m e d i c a l I C U . A n a l g e s i a m a n a g e m e n t i s g e n e r a l l yre la te d to th e p a tie n ts’ d y s y n c h r o n y a n d a g i t a t i o n o n t h e v e n t i l a t o r . A n e wm o d e o f v e n t i l a t i o n ( B i L e v e l ) w a s i n t r o d u c e d t h a t s h o u l d a l l o w t h e p a t i e n t t ob e m o r e c o m f o r t a b l e . T h e c u r r e n t s t u d y c o m p a r e d t h e u s e o f o p i o i d i n M I C Up a t i e n t s b e f o r e a n d a f t e r t h e i n t r o d u c t i o n o f t h e n e w m o d e . M e t h o d s : A s t u d yd o n e i n o u r I C U p r i o r t o t h e i n t r o d u c t i o n o f B i L e v e l q u a n t i t a t e d t h e a m o u n t o fo p i o i d u s e o n m e c h a n i c a l l y v e n t i l a t e d p a t i e n t s . A t t h a t t i m e t h e m o d e o fv e n t i l a t i o n w a s a c o m b i n a t i o n o f A s s i s t C o n t r o l o r S I M V w i t h P r e s s u r eS u p p o r t . T h i s s t u d y w a s u s e d a s t h e b a s e l i n e f o r c o m p a r i s o n . T h e d a t ac o l l e c t i o n m e t h o d s o f t h e p r e v i o u s s t u d y w e r e d u p l i c a t e d o n 10 c o n s e c u t i v ep a t i e n t s v e n t i l a t e d w i t h B i L e v e l . O p i o i d u s a g e w a s c