Keddissi Jean I, Youness Houssein A, Jones Kellie R, Kinasewitz Gary T
Section of Pulmonary, Critical Care and Sleep Medicine, The Oklahoma City VA HealthCare System and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Can J Respir Ther. 2018 Dec 5;55:1-8. doi: 10.29390/cjrt-2018-016. eCollection 2019.
Acute Respiratory Distress Syndrome remains a major source of morbidity and mortality in the modern intensive care unit (ICU). Major advances in the understanding and management of this condition were made in the last two decades. The use of low tidal ventilation is a well-established therapy. Conservative fluid management is now another cornerstone of management. However, much remains to be understood in this arena. Assessing volume status in these patients may be challenging and the tools available to do so are far from perfect. Several dynamic measures including pulse pressures variation are used. Ultrasound of the lungs and the vascular system may also have a role. In addition, the type of fluid to administer when needed is still open to debate. Finally, supportive measures in these patients, early during their ICU stay and later after discharge continue to be crucial for survival and adequate recovery.
急性呼吸窘迫综合征仍然是现代重症监护病房（ICU）发病和死亡的主要原因。在过去二十年中，对这种疾病的认识和管理取得了重大进展。低潮气量通气的使用是一种成熟的治疗方法。保守的液体管理现在是管理的另一个基石。然而，在这个领域仍有许多有待了解的地方。评估这些患者的容量状态可能具有挑战性，并且可用的评估工具远非完美。使用了包括脉压变异在内的几种动态测量方法。肺部和血管系统的超声检查也可能发挥作用。此外，在需要时给予何种类型的液体仍存在争议。最后，在这些患者入住ICU早期及出院后给予支持措施，对于生存和充分康复仍然至关重要。
