Desai Ajay R, Deep Akash
PICU, St. Mary's Hospital, London, United Kingdom.
Indian J Pediatr. 2006 Aug;73(8):661-8. doi: 10.1007/BF02898440.
Acute respiratory distress syndrome, a diagnosis based on physiologic and radiological criteria, occurs commonly in critical care setting. A major challenge in evaluating therapies that may improve survival in ARDS is that it is not a single disease entity but, rather, numerous different diseases that result in endothelial injury, where the most obvious manifestation is within the lung resulting in pulmonary oedema. It has been shown that poor ventilatory technique that is injurious to the lungs can propagate systemic inflammatory response and adversely affect the mortality. The current data suggest that high tidal volumes with high plateau pressures are deleterious and a strategy of ventilation with lower tidal volumes and lower plateau pressure is associated with lower mortality. There may be a role for recruitment manoeuvres as well. Other forms of respiratory support still require further research. The present understanding of optimal ventilatory management and other adjunctive therapies are reviewed.
急性呼吸窘迫综合征是一种基于生理和放射学标准进行诊断的疾病，在重症监护环境中很常见。评估可能改善急性呼吸窘迫综合征患者生存率的治疗方法面临的一个主要挑战是，它不是单一的疾病实体，而是由多种不同疾病导致内皮损伤，其中最明显的表现是肺部出现肺水肿。研究表明，对肺部有害的通气技术不佳会引发全身炎症反应，并对死亡率产生不利影响。目前的数据表明，高潮气量和高平台压是有害的，采用低潮气量和低平台压的通气策略与较低的死亡率相关。肺复张手法可能也有作用。其他形式的呼吸支持仍需进一步研究。本文对目前对最佳通气管理和其他辅助治疗的认识进行了综述。
