ARDS and ECMO, an update on critical care nursing英文文献资料.docVIP

Open Journal of Nursing, 2012, 2, 301-306 OJN /10.4236/ojn.2012.223044 Published Online November 2012 (http://www.SciRP.org/journal/ojn/) ARDS and ECMO, an update on critical care nursing Audrey Courtin, Lucienne Sanchez, Jean-Claude Sinquet, Philippe Gaudard, Jacob Eliet, Frédéric Barge, Pascal Colson Department of Intensive Care, Hopital Arnaud de Villeneuve, Montpellier, France Email: p-colson@chu-montpellier.fr Received 18 September 2012; revised 20 October 2012; accepted 2 November 2012 ABSTRACT 20 years [5,6]. The acute respiratory distress syndrome (ARDS) is a very serious pathology caused by inflammation of the lung, usually infectious or traumatic. The alveoli are filled with inflammatory fluid, impairing gas ex- change. Mechanical ventilation is the inevitable treat- ment, but it must ensure specific levels of alveolar pressure, tidal volume, and positive end-expiratory pressure (PEEP) not to exacerbate inflammation and ARDS. This is called protective ventilation but it does not always guarantee satisfactory blood gases, only the extra-corporeal membrane oxygenation (ECMO) can provide. Management of ARDS patient under ECMO is complex because it combines the care rela- ted to intensive care patient, very restrictive mecha- nical ventilation and ECMO. Intensive care nurse re- quires a very good knowledge of lung disease and re- spiratory assistance constraints, whether ventilatory or extra-corporeal. 2. ARDS, A TERRIBLE CONDITION ARDS is a very serious condition with a high mortality (20% - 40%) [3]. It is caused by inflammation of the lung developing quite rapidly (less than 72 hours), cha- racterized by bilateral opacities visible on chest X-ray without signs of heart failure (pulmonary edema) [1,7]. Severe hypoxia refractory to high oxygen supply deve- lops (PaO2/FiO2 200 mmHg). The inflammation is usually reversible, but pulmonary fibrosis scarring