(精选)【体外膜肺ECMO精品课件】 Advanced Ventilatory Strategies in ARDS教学课件.pptVIP

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2018-03-21 发布于天津
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(精选)【体外膜肺ECMO精品课件】 Advanced Ventilatory Strategies in ARDS教学课件.ppt

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Advanced Ventilatory Strategies in ARDS Alex Yartsev, Dec 2010 Whats the problem in ARDS Thickened diffusion membrane Inflamed exudate-filled alveoli Collapsed bronchioles Lost elasticity of parenchyma Massive shunt Thus, severe hypoxia Challenge to ventilation in ARDS Lung is inelastic: compliance is poor Poor cokpliance = small tidal volume = poor ventilation Poor ventilation = hypercapnoea, acidosis Normal ventilation requires larger volumes… Small changes in volume = large changes in pressure Large changes in pressure = barotrauma Severe hypoxia = high FiO2 requirements High FiO2 for long periods = O2 toxicity The gospel of ARDS net Massive protocol derived from multiple trials “lung protective ventilation” with low tidal volume Aim PaO2 55-80 Tidal volume of ONLY 6ml/kg Pplat to be kept under 30 pH to be kept over 7.30 - ANY ventilator mode Saint Bernadine of SienaSaint of those with lungand respiratory problems Petrucci et al, 2007 Lung protective ventilation strategy for the acute respiratory distress syndrome, Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003844. What can you do with a Drager Evita XL? Quite a lot SIMV PCV (pressure control ventilation) APRV (airway pressure-release ventilation) Pressure control ventilation The target pressure is set, and never exceeded by the machine Tidal volume and minute volume may vary depending on lung compliance and resistance Does not guarantee minute ventilation; guarantees pressure instead Evidence for pressure control ventilation Any better than standard volume control? According to Esteban and co (2000, 79 pts), there was lower mortality in the PCV group… but not because of ventilation (!) Refractory hypoxia was the same, VCV or PCV; but VCV patients died more frequently, … of non-respiratory organ failures. Other trials: Lessard et al. (9 pts, no difference) Rappaport et al (27 patients, fewer ventilated days on PCV) General consensus: studies are underpowered, but trend favours