ARDS患者PEEP滴定调节PPT.ppt

Department of the Intensive Care Unit, the No.4 Hospital Affiliated to Kunming Medical University Xiu Guang-hui Advanced Research Progress of Positive End-Expiratory Pressure Titration after the Alveolar Recruitment Manoeuvre in Patients with Acute Respiratory Distress Syndrome What is Acute Respiratory Distress Syndrome (ARDS)? Injury Disruption of Alveolar Capillary Membrane Non-Cardiogenic Pulmonary Edema Protein-rich Plasma Fluid Hypoxemia Decreased Compliance Mortality Clinical Risk Factors: Direct Lung Injury Indirect Lung Injury Common Causes Pneumonia (Bacteria, Viruses, Fungi) Aspiration of Gastric Contents Uncommon Causes Pulmonary Contusion Fat Embolism Amniotic Fluid Embolism Near-drowning Inhalational Injury (Smoke, NH3) Reperfusion Injury after Transplant Common Causes Sepsis Severe Trauma with Shock Acute Pancreatitis Uncommon Causes Multiple Transfusions Drug Overdose Diffuse Intravascular Coagulation Intact Alveolus AEC-II Infiltration of Inflammatory Cells Denudation of Epithelium Disruption of Alveolar Capillary Membrane Leak of Protein-rich Plasma Fluid Inactivation of Surfactant AM Formation of Provisional Matrix Entrapment of Surfactant Accumulation of Fibroblasts Loss of Functional Airspace PMN AM Provisional Matrix (Fibrin, Fibronectin, Proteoglycans) Insult Infection, Aspiration, Trauma Diffuse Alveolar Damage Pathogenesis of ARDS Reconstitution of Epithelium Removal of Provisional Matrix Apoptosis of Fibroblasts Limiting Myofibroblast Differentiating Repair Fibrosis Impaired Re-epithelialization Further Accumulation of Fibroblasts Myofibroblast Differentiation Deposition and Accumulation of Collagen Pathogenesis of ARDS Degraded Provisional Matrix Chest CT Scan: Bilateral Infiltrates Are Heterogeneous Evolution of Pathogenesis: Exudative Phase (7 Days) Proliferative Phase (14 Days) Fibrotic Phase (21 Days) Alveolar Wall Damage With Flooding Type II Alveolar Cell Hyperplasia Myofibroblast Infiltration Resolution of Edema Exte