ards的吹机械通气.pptVIP

* Fig. 1. Pressure volume relationships in an injured lung with alveolar collapse. Applying positive pressure (lower tracing) first adds little volume, as opening pressures have not been reached. At 10 cm H2O, recruitment begins and volume is delivered. At 30 cm H2O to 35 cm H2O, the lung is stretched maximally and less volume is delivered. The upper tracing reflects deflation and is shifted leftward, reflecting better mechanical function. The lung can remain on the deflation limb with lower pressures needed for ventilation as long as derecruitment is prevented with positive end-expiratory pressure. * Attaining and maintaining alveolar recruitment has three conceptual advantages. First, air spaces patent throughout the ventilatory cycle improve gas exchange [1,5,6,27]. Second, avoiding repetitive alveolar collapse and expansion should reduce VILI [11,17,22]. Third, air spaces patent throughout the ventilatory cycle maintain the surfactant monolayer and thus improve the compliance characteristics (ie, lower airway pressures are required for ventilation as the pressurevolume relationship is shifted to the left) * First, sigh breaths of 1.5 to 2 times the set tidal volume can be applied every minute or so [29]. Second, the PEEP can be temporarily increased so that the subsequent end-inspiratory volume is raised. Third, the tidal volume can be raised temporarily. Fourth, a high level of continuous positive airway pressure (CPAP) can be applied for a set period of time. The CPAP approach is the most widely reported, probably because it is easy to do and because the RM can be applied for a prolonged time (eg, 30 cm H2O to 45 cm H2O CPAP for 30–90 seconds), which may be helpful in recruiting some diseased airspaces. * Because of the technical difficulties with the visual and mechanical techniques noted above, gas-exchange criteria are often used clinically to set PEEP. PEEP一般在患者存在渗透性肺疾病中被加用，肺泡炎症和水肿伴随着表面活性物质的功能不全会产生一些通气不佳的区域，它们在呼吸周期中会完全或部分地（如呼气末）萎陷。 加用PEEP的原则是：这些肺泡可以在潮气量呼吸时