Rialp Gemma, Mancebo Jordi
Servei Medicina Intensiva, Complex Hospitalari de Mallorca, Palça de l'Hospital 3, 07012 Palma de Mallorca, Spain.
Respir Care Clin N Am. 2002 Jun;8(2):237-45, vi-vii. doi: 10.1016/s1078-5337(02)00005-9.
Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure that is characterized by marked hypoxemia, bilateral infiltrates on chest radiograph, and no clinical evidence of left ventricular failure. Mechanical ventilation with positive end-expiratory pressure (PEEP) is a cornerstone therapy for ARDS patients. Because the fundamental aim of supportive treatment is to improve arterial oxygenation, several alternatives to mechanical ventilation with PEEP have been used. One of these alternative therapies is prone positioning, which has been used safely to improve oxygenation in many patients with ARDS. Despite encouraging results, however, the use of prone positioning is not widely accepted as an adjunct to therapy in hypoxemic patients because, aside from temporarily improving gas exchange, it does not seem to affect the outcome of these patients. This article reviews the rationale for using prone positioning in ARDS patients who require intubation and mechanical ventilation.
急性呼吸窘迫综合征（ARDS）是一种严重的呼吸衰竭形式，其特征为显著的低氧血症、胸部X线片显示双侧浸润影，且无左心室衰竭的临床证据。采用呼气末正压（PEEP）的机械通气是ARDS患者的基础治疗方法。由于支持治疗的根本目标是改善动脉氧合，因此人们采用了几种替代PEEP机械通气的方法。其中一种替代疗法是俯卧位通气，已安全用于改善许多ARDS患者的氧合。然而，尽管取得了令人鼓舞的结果，但俯卧位通气作为低氧血症患者治疗辅助手段的应用并未得到广泛认可，因为除了能暂时改善气体交换外，它似乎并不影响这些患者的预后。本文综述了在需要插管和机械通气的ARDS患者中使用俯卧位通气的理论依据。
