【体外膜肺ECMO精品课件】 Broken Lungs.pptVIP

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2018-03-14 发布于天津
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【体外膜肺ECMO精品课件】 Broken Lungs.ppt

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‘Broken Lungs’ Cait P. Searl Consultant Cardiothoracic Anaesthetist / Intensivist Cardiothoracic Transplant Programme Freeman Hospital Newcastle Upon Tyne Hospitals NHS Trust ACUTE RESPIRATORY FAILURE n=1231 ALI n=287 ARDS n=221 Luhr et al, Am J Respir Care Med 1999; 159:1849 Cardiothoracic Transplant Programme Freeman Hospital Newcastle Upon Tyne Hospitals NHS Trust Does the actual diagnosis matter? Cardiothoracic Transplant Programme Freeman Hospital Newcastle Upon Tyne Hospitals NHS Trust Exacerbations of COAD – optimal mode of ventilation? Aim to balance Treatment of hypoxaemia Treatment of hypercapnia Unloading respiratory muscles Managing auto-PEEP Managing atelectasis Cardiothoracic Transplant Programme Freeman Hospital Newcastle Upon Tyne Hospitals NHS Trust Normalisation of milieu Target is normalising blood gases for that patient Cardiothoracic Transplant Programme Freeman Hospital Newcastle Upon Tyne Hospitals NHS Trust Two principles of ‘conventional’ ventilation 1. Lung protection 2. Lung recruitment Cardiothoracic Transplant Programme Freeman Hospital Newcastle Upon Tyne Hospitals NHS Trust Independent lung ventilation Maintaining spontaneous ventilation High frequency ventilation Continuous positioning therapy Prone positioning ECMO iNO Partial liquid ventilation Nebulised prostacyclin Surfactant Anti-inflammatory agents Anti-oxidants iLA i v salbutamol Carbon monoxide etc etc EVIDENCE ??? Respiration Combination of ventilation and perfusion Separate out the ventilation (air in and out) component usually and treat just that. Cardiothoracic Transplant Programme Freeman Hospital Newcastle Upon Tyne Hospitals NHS Trust HFOV High frequency (3-15Hz) oscillation Ventilation (1-4 ml / kg) Theoretically meets goals of protective ventilation and maintains constant lung recruitment. Cardiothoracic Transplant Programme Freeman Hospital Newcastle Upon Tyne Hospitals NHS Trust But... Unproven benefits Disadvantages Cardiothoracic Transplant Programme