急性呼吸窘迫综合征的最新进展。
Update in acute respiratory distress syndrome.
机构信息
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736 South Korea.
出版信息
J Intensive Care. 2014 Jan 3;2(1):2. doi: 10.1186/2052-0492-2-2. eCollection 2014.
Abstract
Acute respiratory distress syndrome (ARDS) is characterized by permeability pulmonary edema and refractory hypoxemia. Recently, the new definition of ARDS has been published, and this definition suggested severity-oriented respiratory treatment by introducing three levels of severity according to PaO2/FiO2 and positive end-expiratory pressure. Lung-protective ventilation is still the key of better outcome in ARDS. Through randomized trials, short-term use of neuromuscular blockade at initial stage of mechanical ventilation, prone ventilation in severe ARDS, and extracorporeal membrane oxygenation in ARDS with influenza pneumonia showed beneficial efficacy. However, ARDS mortality still remains high. Therefore, early recognition of ARDS modified risk factors and the avoidance of aggravating factors during the patient's hospital stay can help decrease its development. In addition, efficient antifibrotic strategies in late-stage ARDS should be developed to improve the outcome.
摘要
急性呼吸窘迫综合征（ARDS）的特征是通透性肺水肿和难治性低氧血症。最近，ARDS 的新定义已经公布，该定义通过根据 PaO2/FiO2 和呼气末正压引入三个严重程度级别，建议针对严重程度的呼吸治疗。肺保护性通气仍然是改善 ARDS 预后的关键。通过随机试验，在机械通气的初始阶段短期使用神经肌肉阻滞剂、严重 ARDS 中的俯卧位通气以及流感肺炎所致 ARDS 中的体外膜氧合显示出有益的疗效。然而，ARDS 的死亡率仍然很高。因此，早期识别 ARDS 并在患者住院期间避免加重因素有助于降低其发生。此外，应开发晚期 ARDS 的有效抗纤维化策略以改善预后。
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