Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Italy.
Curr Opin Crit Care. 2011 Feb;17(1):18-23. doi: 10.1097/MCC.0b013e32834272d8.
To provide the most recent insights on the assessment of gas exchange in acute lung injury.
Central venous blood may be used as a surrogate of arterial blood to assess carbon dioxide tension and acid-base status. In contrast arterial oxygenation cannot be estimated with confidence from venous blood. However, the use of venous blood associated with pulse oximetry may provide the SvO2 which is useful for monitoring and targeting the resuscitation therapy. Impaired CO2 clearance and increased dead space have been confirmed as useful prognostic indices of structural lung damage and mortality in acute respiratory failure. A simplified technique based on multiple inert gas technique has been described to assess ventilation-perfusion mismatch while a new analysis of pulse oximetry has been suggested to detect lung opening and closing. Finally, new insight has been provided on the relationship between lung anatomy, as detected by computed tomography, oxygenation and CO2 clearance.
Although oxygenation assessment is of primary importance during respiratory lung injury, dead space and CO2 retention are more strictly associated with outcome. The association of central venous blood analysis and pulse oximetry may provide more information than arterial blood alone.
提供急性肺损伤中气体交换评估的最新见解。
中心静脉血可作为动脉血的替代物，用于评估二氧化碳张力和酸碱状态。相比之下，不能从静脉血可靠地估计动脉氧合。然而，使用与脉搏血氧饱和度相关的静脉血可能提供 SvO2，这对于监测和靶向复苏治疗是有用的。二氧化碳清除受损和死腔增加已被证实是急性呼吸衰竭中结构性肺损伤和死亡率的有用预后指标。已经描述了一种基于多种惰性气体技术的简化技术来评估通气-灌注不匹配，同时还提出了一种新的脉搏血氧饱和度分析来检测肺开放和关闭。最后，提供了关于计算机断层扫描检测的肺解剖结构、氧合和二氧化碳清除之间关系的新见解。
虽然在呼吸性肺损伤期间，氧合评估是最重要的，但死腔和二氧化碳潴留与预后的关系更密切。中心静脉血分析和脉搏血氧饱和度的联合可能比单独动脉血提供更多信息。
