Prognostic value of pulmonary dead space in patients with the acute respiratory distress syndrome 英文参考文献.docVIP

Matthay and Kallet Critical Care 2011,15:185 /content/15/5/185 COMMENTARY Prognostic value of pulmonary dead space in patients with the acute respiratory distress syndrome Michael A Matthay* and Richard H Kallet 1 2 See related research by Charron et al., /content/15/4/R175/abstract For many years, arterial hypoxemia was considered to Abstract be the primary physiologic abnormality that charac- terized the gas-exchange impairment in critically ill patients with ARDS. As far back as 1975, the inter- relationship between lung recruitment and oxygenation with improvements in both lung compliance and alveolar dead space was elegantly demonstrated by Suter and colleagues [3]. Yet only in the past decade has there been a growing recognition that abnormalities in alveolar A study published in the previous issue of Critical Care demonstrates that measurement of the pulmonary dead-space fraction is superior to hypoxemia as an indicator of a favorable physiologic response to prone positioning in patients with severe acute respiratory distress syndrome. These results add to the growing evidence supporting the clinical and research value of measuring pulmonary dead space in patients with acute respiratory distress syndrome and using this pulmonary physiologic end-point as one indicator of a favorable response to therapy. ventilation and carbon dioxide (CO ) excretion are 2 equally important in contributing to the pulmonary physiologic abnormalities in patients with ARDS. A pros- pective study of 179 patients in whom pulmonary dead space was measured within 24 hours of ARDS onset indicated that dead space was markedly elevated in the In the previous issue of Critical Care, a new study reports early phase of ARDS and was associated with higher that elevated pulmonary dead space is superior to