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[Crit Care最新论文]:有关ARDS患者呼吸支持治疗的专家意见
2017年10月22日 指南导读, 进展交流 暂无评论

REVIEW

Respiratory support in patients with acute respiratory distress syndrome: an expert opinion

Davide Chiumello, Laurent Brochard, John J. Marini, et al

Crit Care 2017; 21: 240

Statements

Noninvasive support, with close monitoring, is a reasonable initial approach in less severely ill patients with ARDS.

对于病情较轻的ARDS患者,在密切监测下的无创通气支持是合理的初始治疗。

PaO2 should be maintained within a normal range (e.g., between 70 and 90 mmHg) or SaO2 between 92 and 97%

PaO2应维持在正常范围(如70-90 mmHg之间)或 SaO2 在 92-97% 之间。

Low tidal volume ventilation, about 6 ml/kg based on predicted body weight, along with an airway plateau pressure ≤ 30 cmH2O should be targeted in most patients with ARDS

对于多数ARDS患者,应采取小潮气量通气(约6 ml/kg理想体重)且气道平台压≤ 30 cmH2O

Recruitment maneuvers can be applied before PEEP selection or in case of abrupt derecruitment

在选择PEEP之前或肺泡突然塌陷时,应当实施肺复张

PEEP selection should be based on various factors, including gas exchange, hemodynamics, lung recruitability, end-expiratory transpulmonary pressure and driving pressure

应当根据多种因素确定PEEP,包括气体交换、血流动力学、肺可复张性、呼气末跨肺压及驱动压

Measurement of esophageal pressure should be considered during both controlled and assisted mechanical ventilation

在控制及辅助机械通气时应考虑测定食道压

In severe ARDS, there is no outcome advantage of using volume-controlled compared to pressure-controlled forms of ventilation

对于重症ARDS,与压力控制通气方式相比,采用定容通气并无预后优势

Use of high-frequency oscillatory ventilation is not recommended

不推荐使用高频振荡通气

Prone positioning should be used in ARDS patients with PaO2/FiO2 < 150 mmHg unless contraindicated

除非有禁忌症,PaO2/FiO2 < 150 mmHg的ARDS患者应采用俯卧位

In moderate/severe ARDS, neuromuscular blocking agents may be useful in the acute phase

对于中重度ARDS患者,神经肌肉阻滞剂在急性期可能有用

Sedation should be reduced and partial ventilator support can be used to promote respiratory muscle activity whenever gas exchange, respiratory mechanics and hemodynamic status have improved

一旦气体交换、呼吸力学及血流动力学状态得以改善,即应减少镇静,采用部分通气支持方式促进呼吸肌肉活动

ECMO should be considered in addition to mechanical ventilation in selected very severe cases of ARDS

对于某些非常严重的ARDS病例,除机械通气外,应考虑ECMO

Use and timing of tracheostomy should be individualized

有关是否需要气管切开及其时机均应个体化决定

Weaning should typically be considered whenever PaO2/FiO2 > 200 mmHg with PEEP < 10 cmH2O, but there are exceptions

当PaO2/FiO2 > 200 mmHg 且 PEEP < 10 cmH2O时,通常应考虑脱机,但也存在例外

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