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老年人群中脓毒症诱发的急性呼吸窘迫综合征的预防性管理

Preventative Management of Sepsis-Induced Acute Respiratory Distress Syndrome in the Geriatric Population.

作者信息

Geyer-Roberts Elizabeth, Lacatusu Diana A, Kester Jessica, Foster-Moumoutjis Gina, Sidiqi Mojda

机构信息

Department of Medicine, Nova Southeastern University (NSU) Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA.

Department of Family Medicine, Nova Southeastern University (NSU) Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA.

出版信息

Cureus. 2023 Feb 6;15(2):e34680. doi: 10.7759/cureus.34680. eCollection 2023 Feb.

Abstract

Sepsis and its treatment are the most common etiologies of acute respiratory distress syndrome (ARDS), which has a disturbing mortality rate. Sepsis management relies heavily on the introduction of resuscitative fluids. However, when fluids are paired with the circulating inflammatory mediators of sepsis, patients are prone to lung damage. Survivors of sepsis-induced ARDS become plagued with functional and/or psychological sequelae such as impaired memory, difficulty in concentrating, and decreased mental processing speed. Specific techniques can be implemented when diagnosing and treating elderly patients with sepsis to prevent the onset of ARDS, including bed elevation and early antibiotics. Additionally, albumin infusion may be beneficial; however, more research must be conducted. Finally, inflammatory mediators, including serum mannose biomarkers and extracellular histone therapy, show a promising avenue for future treatment. Although there is limited research on osteopathic manipulative medicine (OMT) on ARDS or sepsis-induced ARDS, OMT that focuses on alleviating rib and thoracic somatic dysfunctions has been used as an adjunct therapy to treat other respiratory diseases, such as pneumonia and chronic obstructive pulmonary disease (COPD). The results of these studies may garner interest in whether the use of OMT as an adjunct therapy may be beneficial for patients with ARDS or sepsis-induced ARDS. This paper is intended to review the current guidelines for sepsis and ARDS management in elderly patients to identify measures to prevent sepsis-induced ARDS.

摘要

脓毒症及其治疗是急性呼吸窘迫综合征(ARDS)最常见的病因,ARDS的死亡率令人不安。脓毒症的管理在很大程度上依赖于复苏液体的输入。然而,当液体与脓毒症的循环炎症介质同时存在时,患者容易出现肺损伤。脓毒症诱发的ARDS幸存者会受到功能和/或心理后遗症的困扰,如记忆力受损、注意力不集中和心理处理速度下降。在诊断和治疗老年脓毒症患者时,可以采用一些特定技术来预防ARDS的发生,包括抬高床头和早期使用抗生素。此外,输注白蛋白可能有益;然而,还需要进行更多的研究。最后,包括血清甘露糖生物标志物和细胞外组蛋白治疗在内的炎症介质显示出未来治疗的一个有前景的途径。尽管关于整骨手法医学(OMT)对ARDS或脓毒症诱发的ARDS的研究有限,但专注于缓解肋骨和胸部躯体功能障碍的OMT已被用作治疗其他呼吸系统疾病(如肺炎和慢性阻塞性肺疾病(COPD))的辅助疗法。这些研究结果可能会引发人们对于将OMT作为辅助疗法用于ARDS或脓毒症诱发的ARDS患者是否有益的兴趣。本文旨在综述老年患者脓毒症和ARDS管理的现行指南,以确定预防脓毒症诱发的ARDS的措施。

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