Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France.
Minerva Anestesiol. 2012 Aug;78(8):941-8. Epub 2012 Jun 7.
Acute respiratory distress syndrome (ARDS) is a clinical entity involving not only alveolar lesions but also capillary lesions, both of which have deleterious effects on the pulmonary circulation, leading to constant pulmonary hypertension and to acute cor pulmonale (ACP) in 20-25% of patients ventilated with a limited plateau pressure (Pplat). Considering the poor prognosis of patients suffering from such acute right ventricular (RV) dysfunction, RV protection by appropriate ventilatory settings has become a crucial issue in ARDS management. The goal of this review is to emphasize the importance of analyzing RV function in ARDS, using echocardiography, in order to limit RV afterload. Any observed acute RV dysfunction should lead physicians to consider a strategy for RV protection, including strict limitation of Pplat, diminution of positive end-expiratory pressure (PEEP) and control of hypercapnia, all goals achieved by prone positioning.
急性呼吸窘迫综合征（ARDS）是一种临床实体，不仅涉及肺泡病变，还涉及毛细血管病变，这两者都会对肺循环造成有害影响，导致持续的肺动脉高压，并在 20-25%使用限定平台压（Pplat）通气的患者中导致急性肺心病（ACP）。考虑到患有这种急性右心室（RV）功能障碍的患者预后较差，通过适当的通气设置来保护 RV 已成为 ARDS 管理中的关键问题。本综述的目的是强调使用超声心动图分析 ARDS 中 RV 功能的重要性，以限制 RV 后负荷。任何观察到的急性 RV 功能障碍都应促使医生考虑 RV 保护策略，包括严格限制 Pplat、降低呼气末正压（PEEP）和控制高碳酸血症，所有这些目标都可以通过俯卧位来实现。
