呼吸窘迫综合征 必威体育精装版 病历.ppt

呼吸窘迫综合征;病 例;病 例;病 例;病 例;病 例;“Adult Respiratory Distress Syndrome”;What is ARDS;肺损伤评分 – Murray;肺损伤评分 – Murray;ARDS/ALI的定义;Underrecognition by clinicians;Chest X-Ray;X片判读的差异;Standard ventilator settings and PaO2/FiO2;ARDS: clinical criteria vs. autopsy;ARDS: clinical criteria vs. autopsy;ARDS: clinical criteria vs. autopsy;ARDS: clinical criteria vs. autopsy;ARDS: clinical criteria vs. autopsy;ARDS: clinical criteria vs. autopsy;Pathological findings in definition patients without DAD;ARDS/ALI Definition – Best we can do for now…;ARDS;ARDS -- incidence;ARDS -- incidence;ARDS: 危险因素;Trauma Shock Syndromes - Sepsis, Cardiogenic Gastric Aspiration Burns Diffuse Pneumonias Near Drowning Drug Overdose Metabolic Events - Pancreatitis, Uremia Systemic Mediator Release Associated Diseases Disseminated Intravascular Coagulopathy Cardiopulmonary Bypass -- Anaphylaxis Extrapulmonary Infection -- Transfusion Reaction;ARDS -- risk factor;ARDS: 分期;ARDS的发展过程;回到最初的病例…;ARDS – 治疗原则;治疗基础疾病;支持治疗(肺);充分氧合;Acute Respiratory Distress Syndrome;ARDS -- review;Of the 101 investigations mean mortality rate 53%±22% (0-95%) mean PaO2/FiO2 ratio 118±47 (35-270) mean APACHE II score 21.3±6.6 mean LIS 3.1±0.4 no correlation between LIS and mortality;ARDS -- review;ARDS -- review;Acute Respiratory Distress Syndrome;ARDS -- morphology;ARDS -- morphology;ARDS -- PV curve;Ventilator-Induced Lung Injury;ARDS -- VILI;;Normal rat lungs;Alveolar overdistension rather than high proximal airway pressure per se is the primary determinant of this form of VALI the critical variable for injury is not the airway pressure per se, but rather end-inspiratory lung volume or stretch;Atelectrauma: refers to the damage that can occur when lungs are allowed to become atelectatic and then are re-expanded. collapse/re-expansion to be a critical factor causing injury. ;Tidal volume at low airway pressures: lung injury;Tremblay LN, Slutsky AS. Proc Assoc Am Phys 1998; 110:482;Control: VT 7; PEEP 3 MV