ARDS柏林新定义告诉了我们什么概要.pptVIP

ARDS 柏林新定义告诉了我们什么？ Acute Respiratory Distress Syndrome The Berlin Definition JAMA, Published online May 21, 2012 内 容 1. Original Definition of ARDS 2. Multiple different definitions 3. AECC Definition 4. AECC？ 5. The Updated Berlin Definition 6. Comment and conclusion Initial Description The initial description of acute respiratory distress syndrome (ARDS) in adult by Ashbaugh et al in 1967. Original Definition of ARDS “Severe dyspnea, tachypnea, cyanosis that is refractory to oxygen therapy, loss of lung compliance, and diffuse alveolar infiltration seen on chest x-ray.” — Ashbaugh Lancet, 1967 Aug 12; 2(7511): 319-23. Severe dyspnea, tachypnea Cyanosis refractory to oxygen therapy Loss of lung compliance Diffuse alveolar infiltration on chest radiograph Hyperemia, atelectasis, interstitial and alveolar hemorrhage and edema, and hyaline membranes at autopsy √ Original description of ARDS × No specific criteria × Autopsy not usually performed ARDS in 1967 1967 Ashbaugh等 N=12 ( 7例创伤，1例胰腺炎，4例肺炎) 呼吸衰竭 呼吸频速：20-64 bpm 低氧血症：SaO2 41% - 85% 肺顺应性降低：9-19 ml/cmH2O 胸片：早期斑片状阴影 后期浸润扩大 吸氧不能纠正低氧，PEEP部分纠正 尸检：7例 大体：肺重量增加、变硬 肺切面与肝类似 镜下：肺毛细血管充血、扩张 广泛肺泡萎陷 大量中性粒细胞浸润 肺泡内透明膜形成 部分明显间质纤维化 Over the following 45 years multiple different definitions were proposed with varying diagnostic criteria. Definition change of ARDS Original Pepe Murray Delphi Consensus Definition Definition Definition Panel Definition ↓ ↓ ↓ ↓ 1967 → 1976 → 1982→ 1983 → 1988 → 1994 → 2005 → 2012 → ↑ ↑ ↑ ↑ ↑