2013脓毒血症ARDS机械通气指南.docx

Mechanical Ventilation in ARDS Due to SepsisSee All the Surviving Sepsis GuidelinesSepsis is one of the main causes of acute respiratory distress syndrome (ARDS), in which the lungs are injured by circulating inflammatory mediators, resulting in severely impaired gas exchange usually requiring invasive mechanical ventilation. ARDS also results in poor lung compliance in a hetereogeneous distribution, making less-affected lung areas more vulnerable to ventilator-induced lung injury. Sepsis-induced ARDS is a form of severe organ failure, and is a major contributor to the high mortality from severe sepsis and septic shock. Sepsis-induced ARDS most often results from pneumonia, but ARDS can develop as a sequela from sepsis of any infectious source.Mechanical ventilation in ARDS has been examined in numerous well-conducted randomized controlled trials, most of which included patients with severe sepsis and septic shock. Only a handful of studies have considered sepsis-induced ARDS as a distinct entity; most of the evidence supporting the Surviving Sepsis Guidelines for mechanical ventilation in sepsis-induced ARDS derive from evidence collected in ARDS trials in general. The Surviving Sepsis Guidelines for mechanical ventilation of ARDS due to sepsis dont diverge significantly from the general management of ARDS; here is a summary.Low Tidal Volume Ventilation for Sepsis-Induced ARDSTraditional high tidal volumes (10-12 mL/kg) provided during mechanical ventilation can cause barotrauma and are harmful to people with ARDS. Use low tidal volumes of 6 mL/kg of predicted body weight for people with sepsis-induced ARDS (or from any cause). (Strength: Grade 1A, as compared against 12 mL/kg).Predicted body weight is calculated by height; use an online chart or calculator to help you. A 5 9 man would receive 424 mL tidal volumes; a 5 3 woman, only 314 mL. These uncomfortably-low-seeming values may be partly why physicians commonly use inappropriately high tidal volumes in ARDS; i