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中华重症医学电子杂志 ›› 2016, Vol. 02 ›› Issue (04) : 269 -272. doi: 10.3877/cma.j.issn.2096-1537.2016.04.010

所属专题: 重症医学 文献

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急性呼吸窘迫综合征:我选择有创机械通气
章志丹1,()   
  1. 1. 110001 沈阳,中国医科大学附属第一医院重症医学科
  • 收稿日期:2016-11-09 出版日期:2016-11-28
  • 通信作者: 章志丹
  • 基金资助:
    辽宁省自然科学基金(2014021078)

To treat acute respiratory distress syndrom: I prefer invasive mechanical ventilation

Zhidan Zhang1,()   

  1. 1. Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
  • Received:2016-11-09 Published:2016-11-28
  • Corresponding author: Zhidan Zhang
  • About author:
    Corresponding author: Zhang Zhidan, Email:
引用本文:

章志丹. 急性呼吸窘迫综合征:我选择有创机械通气[J/OL]. 中华重症医学电子杂志, 2016, 02(04): 269-272.

Zhidan Zhang. To treat acute respiratory distress syndrom: I prefer invasive mechanical ventilation[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2016, 02(04): 269-272.

急性呼吸窘迫综合征(acute respiratory distress syndrom,ARDS)是一种急性低氧性呼吸衰竭,在重症患者中具有较高的发病率和病死率。肺泡塌陷和肺内分流增加是ARDS主要的病理生理机制。如何有效地开放塌陷的肺泡、降低肺内分流以及改善氧合是ARDS治疗的首要目标。研究显示,小潮气量、高呼气末正压(positive end-expiratory pressure,PEEP)水平、俯卧位通气以及神经肌肉阻滞剂的应用等有创机械通气手段能够显著降低ARDS患者的病死率。因此,对于ARDS的治疗,我选择有创机械通气。

ARDS is an acute hypoxemic respiratory failure, which has a high morbidity and mortarlity rate among critically ill patients. The collapse of alveoli and an increased intrapulmonary shunt are prominent pathophysiology of ARDS.How to recruit the collapsed alveoli and decrease intrapulmonary shunt so as to improve oxygenation are the main targets of ARDS treatment. The use of low tidal volume ventilation, higher PEEP level, prone positioning and neuromuscular blocking agents in mechanical ventilated ARDS patients have been proved effective in decreasing ARDS mortality. So, we prefer to use invasive mechanical ventilation to treat ARDS.

[1]
Ranieri VM, Rubenfeld GD, Thompson BT, et al. ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition[J]. JAMA, 2012, 307(23): 2526-2533.
[2]
Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 Countries[J]. JAMA, 2016, 315(8): 788-800.
[3]
Shekar K, Davies AR, Mullany DV, et al. To ventilate, oscillate, or cannulate?[J]. J Crit Care, 2013, 28(5): 655-662.
[4]
Castillo RL, Carrasco Loza R, Romero-Dapueto C. Pathophysiological approaches of acute respiratory distress syndrome: novel bases for study of lung injury[J]. Open Respir Med J, 2015, 9: 83-91.
[5]
DiRocco JD, Carney DE, Nieman GF. Correlation between alveolar recruitment/derecruitment and inflection points on the pressure-volume curve[J]. Intensive Care Med, 2007, 33(7): 1204-1211.
[6]
Gattinoni L, Marini JJ, Pesenti A, et al. The ″baby lung″ became an adult[J]. Intensive Care Med, 2016, 42(5): 663-673.
[7]
Gattinoni L. How ARDS should be treated[J]. Crit Care, 2016, 20(1):1-3.
[8]
The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and theacute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network[J]. N Engl J Med, 2000, 342(18): 1301-1308.
[9]
Petrucci N, Lacovelli W. Lung protective ventilation strategy for the acute respiratory distress syndrome[J]. Cochrane Database Syst Rev, 2013, 2(3): CD003844.
[10]
Needham DM, Yang T, Dinglas VD, et al. Timing of low tidal volume ventilation and intensive care unit mortality in acute respiratory distress syndrome. A prospective cohort study[J]. Am J Respir Crit Care Med, 2015, 191(2): 177-185.
[11]
Sadowitz B, Jain S, Kollisch-Singule M, et al. Preemptive mechanical ventilation can block progressive acute lung injury[J]. World J Crit Care Med, 2016, 5(1): 74-82.
[12]
Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome[J]. N Engl J Med, 2015, 372(8): 747-755.
[13]
Petty TL, Ashbaugh DG. The adult respiratory distress syndrome.Clinical features, factors influencing prognosis and principles of management[J]. Chest, 1971, 60(3): 233-239.
[14]
Ochiai R. Mechanical ventilation of acute respiratory distress syndrome[J]. J Intensive Care, 2015, 3(1): 1-9.
[15]
Benson AB, Albert RK. Prone positioning for acute respiratory distress syndrome[J]. Clin Chest Med, 2014, 35(4): 743-752.
[16]
Sud S, Friedrich JO, Taccone P, et al.Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis[J]. Intensive Care Med, 2010, 36(4): 585-599.
[17]
Mentzelopoulos SD, Roussos C, Zakynthinos SG. Prone position reduces lung stress and strain in severe acute respiratory distress syndrome[J]. Eur Respir J 2005, 25(3): 534-544.
[18]
Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome[J]. N Engl J Med, 2013, 368(23): 2159-2168.
[19]
Bein T, Grasso S, Moerer O, et al. The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia[J]. Intensive Care Med, 2016, 42(5): 699-711.
[20]
Gattinoni L, Tognoni G, Pesenti A,et al.Effect of prone positioning on the survival of patients with acute respiratory failure[J]. N Engl J Med, 2001, 345(8): 568-573.
[21]
Taccone P, Pesenti A, Latini R,et al.Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial[J]. JAMA, 2009, 302(18): 1977-1984.
[22]
Sud S, Friedrich JO, Adhikari NK, et al.Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis[J]. CMAJ, 2014, 186(10): E381-390.
[23]
Grawe ES, Bennett S, Hurford WE. Early Paralysis for the Management of ARDS[J]. Respir Care, 2016, 61(6): 830-838.
[24]
Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome[J]. N Engl J Med, 2010, 363(12): 1107-1116.
[25]
Chiumello D, Brioni M.Severe hypoxemia: which strategy to choose[J]. Crit Care, 2016, 20(1): 1-9.
[26]
Demoule A, Chevret S, Carlucci A, et al. Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophone countries[J]. Intensive Care Med, 2016, 42(1): 82-92.
[27]
Bellani G, Laffey JG, Pham T, et al. Non-invasive ventilation of patients with ARDS: insights from the lung safe study[J]. Am J Respir Crit Care Med, 2016.
[28]
Chawla R, Mansuriya J, Modi N, et al. Acute respiratory distress syndrome: Predictors of noninvasive ventilation failure and intensive care unitmortality in clinical practice[J]. J Crit Care, 2016, 31(1): 26-30.
[29]
Patel BK, Wolfe KS, Pohlman AS, et al. Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubationin patients with acute respiratory distress syndrome: a randomized clinical trial[J]. JAMA, 2016, 315(22): 2435-2441.
[30]
Messika J, Ben AK, Gaudry S, et al. Use of high-flow nasal cannula oxygen therapy in subjects with ARDS:a 1-year observational study[J]. Respir Care, 2015, 60(2): 162-169.
[31]
Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure[J]. N Engl J Med, 2015, 372(23): 2185-2196.
[32]
Peek GJ, Mugford M, Tiruvoipati R, et al.Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial[J]. BMC Health Serv Res, 2006, 6(1): 1-13.
[33]
Ventetuolo CE, Muratore CS. Extracorporeal life support in critically ill adults[J].Am J Respir Crit Care Med, 2014, 190(5): 497-508.
[34]
Berngard SC, Beitler JR, Malhotra A. Personalizing mechanical ventilation for acute respiratory distress syndrome[J]. J Thorac Dis, 2016, 8(3): E172-174.
[35]
Paternot A, Repessé X, Vieillard-Baron A. Rationale and Description of Right Ventricle-Protective Ventilation in ARDS[J]. Respir Care, 2016, 61(10): 1391-1396.
[36]
Martin-Loeches I, Bos LD, Goligher EC. Will all ARDS patients be receiving mechanical ventilation in 2035? Yes[J]. 2016:1-2.
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