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ALI/ARDS患者肺复苏正确方法的评估

Assessing the Right Strategies in Lung Recruitment for Patients With ALI/ARDS
Disclosures
Neil R. Maclntyre, MD
Introduction
A panel discussion was convened at the 32nd Critical Care Congress to review and update a number of aspects of mechanical ventilation having to do with recruitment and positive end-expiratory pressure (PEEP). Present were John J, Marini, MD,[1] of St. Paul Ramsey Medical Center in St. Paul, Minnesota; Thomas Stewart, MD,[2] of Mount Sinai Medical Center in Oakville, Ontario, Canada; Robert Kacmarek, RRT, PhD,[3] of Massachusetts General Hospital in Boston, Massachusetts; and Roy Brower MD,[4] of Johns Hopkins Hospital in Baltimore, Maryland.

　　Parenchymal Lung Injury Effects on Alveolar Structure and Function
　　Restoring Alveolar Structure and Function in Parenchymal Lung Injury
Conclusions
Parenchymal lung injury produces alveolar damage and collapse, resulting in abnormal gas exchange and reduced compliance. PPV with an inflation to physiologic maximal pressures (RM) can open (recruit) some (but not all) such alveoli, and PEEP can prevent the subsequent de-recruitment. Because parenchymal lung injury is heterogeneous, a certain RM and PEEP strategy may be efficacious in some units but suboptimal or harmful in others (VILI). Applying RMs and PEEP is often guided by gas exchange and mechanical parameters. Outcome improvement from these approaches has yet to be shown.
References
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