Malhotra Atul
Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
N Engl J Med. 2007 Sep 13;357(11):1113-20. doi: 10.1056/NEJMct074213.
A 55-year-old man who is 178 cm tall and weighs 95 kg is hospitalized with community-acquired pneumonia and progressively severe dyspnea. His arterial oxygen saturation while breathing 100% oxygen through a face mask is 76%; a chest radiograph shows diffuse alveolar infiltrates with air bronchograms. He is intubated and receives mechanical ventilation; ventilator settings include a tidal volume of 1000 ml, a positive end-expiratory pressure (PEEP) of 5 cm of water, and a fraction of inspired oxygen (FiO) of 0.8. With these settings, peak airway pressure is 50 to 60 cm of water, plateau airway pressure is 38 cm of water, partial pressure of arterial oxygen is 120 mm Hg, partial pressure of carbon dioxide is 37 mm Hg, and arterial blood pH is 7.47. The diagnosis of the acute respiratory distress syndrome (ARDS) is made. An intensive care specialist evaluates the patient and recommends changing the current ventilator settings and implementing a low-tidal-volume ventilation strategy.
一名55岁男性，身高178厘米，体重95公斤，因社区获得性肺炎和进行性加重的呼吸困难入院。他通过面罩吸入100%氧气时的动脉血氧饱和度为76%；胸部X线片显示弥漫性肺泡浸润伴空气支气管征。他接受了气管插管并进行机械通气；呼吸机设置包括潮气量1000毫升、呼气末正压（PEEP）5厘米水柱和吸入氧分数（FiO）0.8。在这些设置下，气道峰压为50至60厘米水柱，平台气道压为38厘米水柱，动脉血氧分压为120毫米汞柱，二氧化碳分压为37毫米汞柱，动脉血pH值为7.47。诊断为急性呼吸窘迫综合征（ARDS）。一名重症监护专家对患者进行评估，并建议改变当前的呼吸机设置并实施低潮气量通气策略。
