ARDS改-培训课件.ppt

Everything hinges on the matter of evidence Carl Sagan Pressure-controlled Ventilation (PCV)压力控制通气 Time-cycled mode Approximate square waves of a preset pressure are applied and released by means of a decelerating flow 近似方形压力曲线并通过减速释放 More laminar flow at the end of inspiration 在吸气末有更多的层流 More even distribution of ventilation in patients with marked different resistance values from one region of the lung to another Pressure-controlled Inverse-ratio Ventilation 压力控制反比通气 Conventional常规 inspiratory-expiratory ratio is reversed (I:E 2:1 to 3:1) Longer time constant比较久的时间常数 Breath starts before expiratory flow from prior breath reaches baseline ? auto-PEEP with recruitment of alveoli Lower inflating pressures较低的压力 Potential for decrease in cardiac output due to increase in MAP 因为增加平均动脉压，可能减少心排量 Extracorporeal Membrane Oxygenation (ECMO)体外膜式氧合作用 Zapol WM et al. JAMA 1979;242(20):2193-6 Prospectively randomized 90 adult patients Multicenter trial Conventional mechanical ventilation vs. mechanical ventilation supplemented with partial venoarterial bypass No benefit Partial Liquid Ventilation (PLV) 部分液体通气 Ventilating the lung with conventional ventilation after filling with perfluorocarbon 在肺内充满全氟碳后进行常规通气 Perflubron 20 times O2 and 3 times the CO2 solubility Heavier than water比水重 Higher spreading coefficient较高的展布系数 Studies in animal models suggest improved compliance and gas exchange 动物模型研究证明可改善气体交换及顺应性 Partial Liquid Ventilation (PLV) CL Leach, et al. NEJM 1996;335:761-7. The LiquiVent Study Group 13 premature infants with severe RDS refractory to conventional treatment No adverse events Increased oxygenation and improved pulmonary compliance增加氧合作用并且改善肺的顺应性 8 of 10 survivors Partial Liquid Ventilation (PLV) Hirschl et al JAMA 1996;275:383-389 10 adult patients on ECMO with ARDS Ann Surg 1998;228(5):692-700 9 adult patients with ARDS on conventional mechanical ventilation Improvements in gas exchange with few complications改进气体交换并且并发症少 No r