1 Institute of Anaesthesiological Pathophysiology and Process Engineering, University Medical School, Ulm, Germany.
2 Section of Anesthesia, Analgesia, Perioperative, and Intensive Care, Department of Medical, Oral, and Biotechnological Sciences, School of Medicine and Health Sciences, "SS. Annunziata" Hospital, "Gabriele d'Annunzio" University of Chieti-Pescara, Chieti, Italy; and.
Am J Respir Crit Care Med. 2017 Oct 15;196(8):964-984. doi: 10.1164/rccm.201610-2156SO.
Acute respiratory distress syndrome (ARDS) is characterized by severe impairment of gas exchange. Hypoxemia is mainly due to intrapulmonary shunt, whereas increased alveolar dead space explains the alteration of CO clearance. Assessment of the severity of gas exchange impairment is a requisite for the characterization of the syndrome and the evaluation of its severity. Confounding factors linked to hemodynamic status can greatly influence the relationship between the severity of lung injury and the degree of hypoxemia and/or the effects of ventilator settings on gas exchange. Apart from situations of rescue treatment, targeting optimal gas exchange in ARDS has become less of a priority compared with prevention of injury. A complex question for clinicians is to understand when improvement in oxygenation and alveolar ventilation is related to a lower degree or risk of injury for the lungs. In this regard, a full understanding of gas exchange mechanism in ARDS is imperative for individualized symptomatic support of patients with ARDS.
急性呼吸窘迫综合征（ARDS）的特征是严重的气体交换受损。低氧血症主要是由于肺内分流，而增加的肺泡死腔解释了 CO 清除率的改变。评估气体交换受损的严重程度是对该综合征进行特征描述和评估其严重程度的必要条件。与血流动力学状态相关的混杂因素会极大地影响肺损伤的严重程度与低氧血症的程度和/或通气机设置对气体交换的影响之间的关系。除了抢救治疗的情况外，与预防损伤相比，ARDS 患者的目标是优化气体交换的情况已变得不那么重要。临床医生面临的一个复杂问题是，要了解当氧合和肺泡通气改善与肺损伤的程度或风险降低相关时，应如何处理。在这方面，充分了解 ARDS 中的气体交换机制对于 ARDS 患者的个体化症状支持至关重要。
