Tomicic V, Fuentealba A, Martínez E, Graf J, Batista Borges J
Unidad de Cuidados Intensivos, Clínica Alemana de Santiago, Unidad de Paciente Crítico, Hospital Padre Hurtado, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
Med Intensiva. 2010 Aug-Sep;34(6):418-27. doi: 10.1016/j.medin.2009.10.005. Epub 2010 Jan 25.
Acute Respiratory Distress Syndrome (ARDS) is understood as an inflammation-induced disruption of the alveolar endothelial-epithelial barrier that results in increased permeability and surfactant dysfunction followed by alveolar flooding and collapse. ARDS management relies on mechanical ventilation. The current challenge is to determine the optimal ventilatory strategies that minimize ventilator-induced lung injury (VILI) while providing a reasonable gas exchange. The data support that a tidal volume between 6-8 ml/kg of predicted body weight providing a plateau pressure < 30 cmH₂O should be used. High positive end expiratory pressure (PEEP) has not reduced mortality, nevertheless secondary endpoints are improved. The rationale used for high PEEP argues that it prevents cyclic opening and closing of airspaces, probably the major culprit of development of VILI. Chest computed tomography has contributed to our understanding of anatomic-functional distribution patterns in ARDS. Electric impedance tomography is a technique that is radiation-free, but still under development, that allows dynamic monitoring of ventilation distribution at bedside.
急性呼吸窘迫综合征（ARDS）被认为是一种由炎症引起的肺泡内皮 - 上皮屏障破坏，导致通透性增加和表面活性剂功能障碍，随后出现肺泡积液和塌陷。ARDS的治疗依赖于机械通气。当前的挑战是确定最佳通气策略，在提供合理气体交换的同时，将呼吸机诱导的肺损伤（VILI）降至最低。数据支持应使用预测体重6 - 8 ml/kg的潮气量，使平台压<30 cmH₂O。高呼气末正压（PEEP）并未降低死亡率，但次要终点有所改善。使用高PEEP的理论依据是它可防止气腔的周期性开放和关闭，这可能是VILI发生的主要原因。胸部计算机断层扫描有助于我们了解ARDS中的解剖 - 功能分布模式。电阻抗断层扫描是一种无辐射但仍在开发中的技术，可在床边动态监测通气分布。
