呼吸治疗肺保护施丽萍课件.ppt

呼吸机治疗的肺保护策略;呼吸机相关性肺损伤 acute parenchymal lung injury and an acute inflammatory response in the lung. cytokines →alveoli and the systemic circulation →multiple organ dysfunction mortality↑ ;呼吸机相关性肺损伤ventilator-induced lung injury;肺 损 伤 病 理; Approaches in the management of acute respiratory failure in children protective ventilatory and potential protective ventilatory modes lower tidal volume and PEEP permissive hypercapnia high-frequency oscillatory ventilation airway pressure release ventilation partial liquid ventilation improve oxygenation recruitment maneuvers prone positioning kinetic therapy reduce FiO2 and facilitate gas exchange inhaled nitric oxide and surfactant Curr Opin Pediatr. 2004 Jun;16(3):293-8. ;Can mechanical ventilation strategies reduce chronic lung disease? continuous positive airway pressure permissive hypercapnia patient-triggered ventilation volume-targeted ventilation proportional assist ventilation high-frequency ventilation Semin Neonatol. 2003 Dec;8(6):441-8 ;小潮气量和呼气末正压 lower tidal volume and PEEP;Ventilation with lower tidal volumes versus traditional tidal volumes in adults for ALI and ARDS 1202 patients lower tidal volume (≤7ml/kg) low plateau pressure ≤30 cm H2O versus tidal volume 10 to 15 ml/kg Mortality at day 28 ? long-term mortality was uncertain low and conventional tidal volume with plateau pressure ≤31 cm H2O was not significantly different Cochrane Database Syst Rev. 2004;(2):CD003844  ;Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome;Increasing inspiratory time exacerbates ventilator-induced lung injury during high-pressure/high-volu