肺保护机械通气seminar2008aPPT.ppt

Lung Protective Mechanical Ventilation肺保护性机械通气Adoption discussion;Ventilator Induced Lung InjuryVILI;Overdistention Barotrauma Volutrauma;VILI： Recruitment/Derecruitment Injury ;Translocation of Cells;Ventilatory Strategy and BAL Cytokines;Arthur S Slutsky;Serum Cytokines in Acid Aspiration ModelChiumello, Pristine, Slutsky AJRCCM 1999;160:109-16;Cytokines in HumansStuber et al Int Care Med 2002;28:834-841;;Systemic Effects of VILIImai et al JAMA 289:2104-2112,2003;Biophysical Injury;Hudson et al, Chest 116:74S-2S;;Shanghai ARDS Study Group.;Protect the lungs? ;Protect the lungs? How?;MARCELO AMATO, M.D.,et al. (N Engl J Med 1998;338:347-54.);METHODSStudy Population;Marcelo BP Amato, MD;PV curve (static);Optimal PEEP;Recruitment Maneuver;Performance of RM @ MGH;Performance of RM @ MGH;Monitoring during RM (MGH);Amato NEJM 1998;338:347;Amato: 2004 China;Amato;Recruit;WAIT;J. J. HAITSMA, B. LACHMANNMINERVA ANESTESIOL 2006;72:117-32;Stepwise Recruitment Strategy;MARCELO AMATO, M.D.,et al. (N Engl J Med 1998;338:347-54.);Lim CCM 2001;29:1255;Foti ICM 1999;26:501;Treatment with Oscillation and an Open Lung strategy (TOOLS)Crit Care Med 2005; 33(3): 479 ;Stepwise PEEP recruitment maneuvers (Amato’s team);Stepwise PEEP RM practice;RM in our ICU;方 法;Protocol;结 果;Subcutaneous emphysema;临床观察;Use of dynamic compliance for open lung positive end-expiratory pressure titration in an experimental study;Result;;Clinical Observation;;;Clinical Observation;;;Performance of RM;Performance of RM - PCV;Performance of RM - PCV;Lung Recruitment;Current conclusion;Guidelines? Not available yet;Titrating PEEP fellowing RM;PV curve for Pdeflex;Pflex;Anesthesiology, V 99, No 5, Nov 2003Khaled A. Sedeek, M.D.,* Muneyuki Takeuchi, M.D.,* Klaudiusz Suchodolski, M.D.,* Sara O. Vargas, M.D.,?Motomu Shimaoka, M.D.,? Jay J. Schnitzer, M.D.,§ Robert M. Kacmarek, R.R.T., Ph.D.;Titrating PEEP according to oxygenation; Patients ( n=549 ) ARDS/