2020年ARDS肺复张的实施.ppt

* Why does V/Q matching matter? And….. Why does the supine position contribute to a V/Q mismatch for the ARDS patient? We have to have two things in order for diffusion to occur successfully. We have to have gas in the alveoli and we have to have adequate perfusion in the capillary. When the blood and gas match, diffusion is an efficient process for oxygen delivery. When all goes well, Oxygen will diffuse from the alveoli into the capillary and CO2 will diffuse from the capillary into the alveoli to be removed through exhalation based upon a simple pressure gradient. There are several factors that can hinder this process in an injured or diseased lung. If we have inadequate ventilation, inadequate perfusion or a diffusion defect, Oxygen delivery can be impaired. If we have a decreased (low) V/Q ratio, the result is typically some degree of pulmonary shunting. Pulmonary shunting is defined as that portion of the cardiac output (blood) that enters the left side of the heart without exchanging gases with alveolar gases. Normal physiologic shunt is 3-5% of the Cardiac Output. This is due to the bronchial, pleural, and thebesian venous drainage back into the left heart. Capillary shunting is commonly caused by (1) alveolar collapse or atelectasis, (2) alveolar fluid accumulation , or (3) alveolar consolidation. In other words, poor ventilation. This, put into simple clinical terms, means that we have perfusion passing by alveolar units that are not ventilated, and therefore unable to participate in gas exchange. The consequence is blood that is passing through the pulmonary vault without being re-oxygenated and would be evidenced by a decrease in arterial oxygen tension. Oxygen delivery is compromised. The sum of the anatomic and capillary shunts is referred to as true, or absolute shunt. Absolute shunt is refractory to oxygen therapy. That is, the hypoxemia produced by this form of pulmonary shunting cannot be treated by simply increasing the concentration of in