(精编)【体外膜肺ECMO精品课件】 Adult Respiratory Distress Syndrome.pptVIP

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2018-03-21 发布于天津
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(精编)【体外膜肺ECMO精品课件】 Adult Respiratory Distress Syndrome.ppt

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Nutrition High-Fat, Low-Carbohydrate Diet Reduces the duration of ventilation in patients receiving mechanical ventilation Reduces the respiratory quotient and the level of carbon dioxide Al-Saady NM, et al. Intensive Care Med. 1989;15:290-295 Nutrition Immunomodulatory Nutrients Amino acids such as arginine and glutamine, ribonucleotides, and omega-3 fatty acids. Meta Analysis: decrease in infectious complications and duration of hospital stay Hays SD. Ann Surg 1999;229:467-477 Nitric Oxide Vasodilatory effects are restricted to the blood vessels at the site of generation or administration since it is rapidly inactivated NO inhalation dilates pulmonary vessels perfusing aerated lung units, diverting blood flow from poorly ventilated or shunt regions Potential treatment for pulmonary hypertension and severe hypoxemia in ARDS Nitric Oxide Prospective, multicenter, randomized, double-blind, placebo-controlled trial on inhaled nitric oxide in ARDS 208 patients Payen D et al. Intensive Care Med 1999;25:s166 No effect on mortality or the duration of mechanical ventilation There may be a role for NO in some ALI/ARDS patients with severe refractory hypoxemia and pulmonary arterial hypertension Surfactant Replacement Therapy Multicenter, randomized, placebo-controlled trial in 725 patients with sepsis-induced ARDS Artificial protein-free surfactant given by aerosol did not affect arterial oxygenation, duration of mechanical ventilation, or survival Anzueto A et al: N Eng J Med 334:1417-1421, 1996 Adult Respiratory Distress Syndrome Mazen Kherallah, MD, FCCP The Inexact Definition for ARDS Contributes to difficulty in management ARDS and ALI consensus statement definitions Acute onset (not specified) Po2/FiO2 ratio 200 (300 for ALI) Bilateral infiltrates on chest radiograph (highly variable) PAWP18 mm Hg or absence of clinical evidence of volume overload Bernard GR et al, Am J Resp Crit Care Med. 1994;149:818-824 The Nature of Acute Lung Injury Pulmonary events Infec