ARDS 呼吸窘迫综合征.ppt

Plasma Cytokine Levels PPLAT (cmH2O) R2 = 0.795 P = 0.001 “tidal hyperinflation” ( % total tidal inflation-related change in CT lung volume) Cytokine concentration/ventilator free days = a x LUNG WEIGHT b x P/F c x Pplat d x tidal hyperynflation e x tidal recruitment f x protected tidal inflation multivariate stepwise regression analysis with backward elimination Cytokine concentration/ventilator free days = a x LUNG WEIGHT b x P/F c x Pplat d x tidal hyperynflation e x tidal recruitment f x protected tidal inflation multivariate stepwise regression analysis with backward elimination P 0.01 Hyperinflated Normally aerated Poorly aerated Not aerated -1000 -900 -500 -100 EI EE -20 40 60 120 0 Protected Delta vol (ml) Hounsfield Units EI EE Hyperinflated Normally aerated Poorly aerated Not aerated -1000 -900 -500 -100 -20 40 80 120 Hounsfield Units Delta vol (ml) Not Protected 0 STRESS NO STRESS 0 10 6 2 from systemic inflammation to clinical outcome : MOSF Ranieri VM, Giunta F, Suter PM, Slutsky AS, JAMA 2000; 284: 43-44 mechanical ventilation can lead to end-organs epithelial cell apoptosis this is accompanied by biochemical markers of organ dysfunction explain the high rate of MODS seen in patients with ARDS and the decrease morbidity and mortality observed in patients treated with protective ventilatory strategy Question 4 What are the indications for NPPV in patients with ARF? Antonelli et al: N Engl J Med 1998; 339: 429-435 What are the indications for NPPV in patients with ARF? HYPOXIC RESPIRATORY FAILURE Significant controversy exists concerning the exact indications for NPPV NPPV in ALI/ARDS A single study has demonstrated NPPV to be an adequate alternative to conventional invasive ventilation in such patients Larger, controlled studies are required to determine the potential benefit of adding NPPV to standard medical treatment in the avoidance of endotracheal intubation in hypoxemic ARF 15 authors “all stars”