Boyadjiev I, Albanèse J
Département d'anesthésie et de réanimation, hôpital Nord, boulevard Pierre-Dramard, 13915 Marseille cedex 20, France.
Ann Fr Anesth Reanim. 2008 Jul-Aug;27(7-8):604-10. doi: 10.1016/j.annfar.2008.04.013. Epub 2008 Jun 26.
To assess the role of sedation and myorelaxant agents in acute respiratory distress syndrome (ARDS) and to propose an updated management according to recent literature. EXTRACTION OF DATA: From Medline and Cochrane database of English and French language articles. Keywords were: acute respiratory distress syndrome, acute lung injury, general anaesthetics, inhalation, intravenous anaesthetics and intensive care. Selection of original articles, reviews and expert reports. Case reports have been included.
ARDS is a clinical picture in which respiratory constraints are major because of hypoxemia. To insure correct haematosis, mechanical ventilation has to be considered. It constitutes, then, the most frequent indication of sedation in the intensive care unit. The objectives are to help the ventilation of lungs and to improve gas exchange, by controlling agitation, fight against ventilation and to reduce mechanical ventilation associated injuries. In this situation, use of myorelaxant agents is aimed at facilitating synchronization of the patient with his/her ventilator and serves to improve oxygenation during the early inflammatory phase of ARDS. Several mechanisms may enflame this improvement of oxygenation. One of the most probable effect on optimization is the possibility of optimize protective ventilation at the cares phase of ARDS and to reduce mechanical ventilation-associated injuries.
With regard to benefits and inconvenient, sedation is considered as a treatment of ARDS. Its goals are the well being of patient and his/her adaptation to ventilator, but also the prevention on mechanical ventilation associated injuries. Hence, most authors suggest using a deep sedation at the early phase of ARDS. In this contact, use of myorelaxant agent is an intersecting adjuvant if sedation is not enough. The benefit is terms of survival and outcome remains to show.
评估镇静剂和肌松剂在急性呼吸窘迫综合征（ARDS）中的作用，并根据近期文献提出更新的管理建议。
从Medline和Cochrane数据库中检索英文和法文文章。关键词为：急性呼吸窘迫综合征、急性肺损伤、全身麻醉药、吸入、静脉麻醉药和重症监护。选择原创文章、综述和专家报告。病例报告也被纳入。
ARDS是一种临床病症，其中由于低氧血症导致呼吸受限是主要问题。为确保正确的血液状态，必须考虑机械通气。因此，它构成了重症监护病房中最常见的镇静指征。目标是通过控制躁动、对抗通气并减少与机械通气相关的损伤，来帮助肺部通气并改善气体交换。在这种情况下，使用肌松剂旨在促进患者与呼吸机同步，并在ARDS的早期炎症阶段改善氧合。几种机制可能引发这种氧合改善。最可能对优化产生影响的一个因素是在ARDS的护理阶段优化保护性通气并减少与机械通气相关损伤的可能性。
关于利弊，镇静被视为ARDS的一种治疗方法。其目标是患者的舒适及其对呼吸机的适应，同时也是预防与机械通气相关的损伤。因此，大多数作者建议在ARDS早期使用深度镇静。在这种情况下，如果镇静不足，使用肌松剂是一种辅助手段。其对生存和预后的益处仍有待证明。
