教学文档资料教程.pptVIP

Reversibility of Lung Collapse and Hypoxemia in Early Acute Respiratory Distress Syndrome;Introduction;Detrimental Collapse Hypothesis;New maximum recruitment strategy;;Methods: Patients and Monitoring;Methods: Experimental Protocol;4 min;Methods: OLA;Methods: Maximum-Recruitment Strategies;First step (peak pressure 40cmH2O) was applied to all. All next steps were conditional on measurements collected at the end of previous resting phase ~ Protocol was interrupted whenever Blood-gas target: PaO2 + PaCO2 ≧ 400mmHg Mixed venous oxygen saturation 80% Mean arterial pressure 60 mmHg Development of barotrauma (on CT images);If target was not met despite inspiratory pressures of 60cmH2O, the maneuver was terminated recruitment was considered incomplete. 26 patients receive maximum-recruitment strategy First 11 patients at the CT scanner Remaining 15 patients in the ICU ;Methods: PEEP titration;Methods: Quantitative CT Image Analysis;Methods: Statistical Analysis;Results: Characteristics of Patients;;;Results: Efficacy of Stepwise Maximum-Recruitment Strategy;*p 0.001; ?p 0.005; ?p 0.03;;;Results: Maintaining Benefits of Recruitment;;Results: Side Effects of Stepwise Maximum-Recruitment Strategy;;;Results: Correlation between oxygenation and quantitative CT analysis;;Figure 7: Percent-volume calculations systematically underestimated the percent-mass calculations Inverse correlation bet. PaO2 PaCO2 (p 0.001) Sensitivity/specificity analysis confirmed the tight correlation between CT analysis and blood gases: PaO2 + PaCO2 400 mm Hg indicated a lung condition with more than 5% of collapse 85% sensitivity and 82% specificity;;;Discussion: Major findings;Success rate and magnitude of lung recruitment in this study were unusual, ... Antiderecruitment strategy with PEEP levels kept at 25 cmH2O during the whole recruiting phase. Work as a recruitment keeper ~ Decremental PEEP titration detected optimum PEEP, resulting in average PEEP of 20 cmH2O. Still above a