ARDS肺复张实施分析.pptVIP

Multiple Maneuvers May Be Needed For Optimum RM Effect Fujino et al, Crit Care Med 2001; 29(8):1579-1586 Post-RM PEEP Determines PaO2 Averaged data from three models RM S-C Lim, CCM 2004 Transient Benefit Post-RM-PEEP－肺开放效应持续时间的决定因素 CCM, 2004, 32: 2371-2377 28 mixed-breed pigs Models of ARDS: OA VILI Pneumonia(PNM) RM SI Increased PEEP PCV 肺开放后的PEEP选择----PaO2/FiO2 1. RM后 PEEP: 20cmH2O 2. PEEP递减: 2cmH2O/5min 3. PEEP阈值: PaO2/FiO2400的PEEP 或PaO2/FiO2 降低5% 4. PEEP: PEEP阈值 +2cmH2O BASELINE VENTILATION Tidal volume=6ml/kg PEEP=5cmH2O Modify PEEP to get a 1.1ｂ0.9 recruiting maneuver