(精选)ARDS教学课件.pptVIP

ARDS;DIAGNOSTIC CRITERIA;Clinical diagnosis;Clinical disorders associated with ARDS;Clinical disorders associated with ARDS;CLINICAL MANIFESTATIONS;Laboratory studies;Leukocytosis/Leukopenia/anemia are common Renal function abnormalities/or liver function Von willebrand’s factor or complement in serum may be high Acute phase reactants like ceruloplasmin or cytokine (TNF,IL-1,IL-6,IL-8) may be high.;Therapy -goals;Respiratory Support;Spontaneously Breathing Patient;Indications for mechanical ventilation;Mechanical Ventilation;Start with FiO2 = 1.0, tidal volume 6 to 10 ml per Kg, PEEP = 5 cm H2O and inspiratory flow rates ~ 60 L / min. Subsequent adjustments are done to try to achieve arterial oxygen sats. of 90% with FiO2 0.6 and peak airway pressures 40 to 45 cm H20 Controlled Mandatory Ventilation (CMV) with sedation and neuromuscular blockade (to try to suppress the respiratory drive and reduce respiratory muscle oxygen requirement.);PEEP improves PaO2 in most patients and allows reduction of FiO2. Increase by 2 to 5 cm H2O increments every 20 min watching for hemodynamic deterioration (due to impaired venous return and decreased cardiac out put). Optimal PEEP is usually 10 to 15 cm H2O Inverse Ratio Ventilation may decrease peek inflation pressures and thus Barotrauma. Inspiratory time : Expiratory time ratio (I:E ratio) of between 1:1 and 4:1 may be tried.;The ventilatory rate required to clear CO2 and normalize pH is commonly high (20 to 25 breaths / min). However this may result in unacceptable airway pressures. Another strategy is’ permissive hypercapnoea’ which as the name suggests is controlled hypoventilation. PaCO2 up to 13 kPa is generally well tolerated; acidosis (pH 7.25) may be treated with intravenous bicarbonate ;Changing the patients position (lateral decubitus or prone instead of supine) can improve oxygenation by improving perfusion of aerated portion of lung. Consider this in patients with non uniform or predominantly posterior and lower