ARDS机械通气参数设置.pptVIP

高PEEP和低PEEP预后相同？ N Engl J Med，2004，35l：327-336． 两组患者基线资料差异可能是原因之一 ARDS肺通气的不均一性 * Panel A shows the mortality rate in the ICU (mean length of stay, 29±27 days; range, 2 to 163) among patients with acute lung injury or ARDS (P = 0.34 by the Hosmer–Lemeshow goodness-of-fit test; C = 0.72). Results are shown for quartiles of 17 patients each according to the percentage of potentially recruitable lung. * * Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome * The homogeneity of diversity * ARDS肺重量可增加数倍，导致重力依赖区压缩性肺不张，其次心脏压迫和腹压增高也起作用，俯卧位时，胸壁顺应性减低，肺密度重新分配，解剖学上背部肺区复张 面积大于腹部肺区压缩， 肺顺应性改善 * The combined cohort (with 1249 death events) was partitioned into 15 quantiles of ΔP, and the relative risk for each quantile was calculated in relation to the mean risk of the combined population (assumed to be 1).The mean risk and 95% confidence intervals (error bars) for each percentile were calculated after multivariate adjustment at the patient level (Cox proportional-hazards model) for the five covariates (trial, age, risk of death according to APACHE or SAPS, arterial pH at entry, and Pao2:Fio2 at entry) specified in model 1. The gray zone represents the 95% confidence interval for the Cox regression (dashed line) across the whole population when ΔP is considered as a continuous variable.合并的队列（1249个死亡事件）被划分为15对Δp分位数，和各分量的相对风险计综合人口的平均风险（假定为1）。每个百分位的平均风险和95%置信区间（误差）在病人的水平多因素调整后计算（Cox比例风险模型）的五个协变量（试验，年龄，死亡风险根据Apache或汁液，加入时，动脉血pH、PaO2 FiO2入口）：模型1。灰色区域代表95%可信区间在Cox回归（虚线）在整个人口的时候Δ被认为是一个连续变量。 * ARDS机械通气参数设置：小潮气量、低平台压、高PEEP，够吗？ ARDS陷闭肺组织与死亡率相关 临床研究: 塌陷肺泡越多, 病死率越高 N Engl J Med，2006 27;354(17):1775-86. ARDS患者肺形态学：婴儿肺 Puybasset L,. Intensive Care Med 2000; 26: 857-869 2,095 ml 877 ml ---核心问题是功能肺组织（可通气肺容积）减少，肺功能表现为功能残气量降低 Pathogenesis of ventilator-induced lung injury Global stress/strain reduced by loweing Ptp Local stress/strain less if Ptp is more homogeneously appliied(prone position) Local stress/strain if PEEP ”keeps open