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The management of acute respiratory distress syndrome

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Dang Thanh Tuan
Dang Thanh Tuan
Gesundheit & Medizin
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The Management of Acute Respiratory Distress Syndrome çœČç«‹æĄƒćœ’é†«é™ą èƒžè…”ć…§ç§‘ æž—ć€Źçżé†«ćž«
Outlines ,[object Object],[object Object],[object Object],[object Object]
ćźšçŸ© Definition ,[object Object],[object Object],[object Object],[object Object]
è‡Žç—…ćŽŸć›  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Differential Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lancet 2007; 369:1553-65
Prognosis & Outcome ,[object Object],[object Object],[object Object],[object Object],Lancet 2007; 369:1553-65
Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lancet 2007; 369:1553-65
NEJM 2000;342:1334-1349
NEJM 2000;342:1334-1349
NEJM 2000;342:1334-1349
Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Supportive Care ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ventilator Strategy
Ventilator-induced Lung Injury (VILI) ,[object Object],[object Object],[object Object],[object Object],Over Distension Collapse
Volutrauma ,[object Object],[object Object],[object Object],[object Object],AJRCCM 1998; 157: 294-323
Atelectrauma ,[object Object],[object Object],[object Object],PEEP PEEP PEEP Lung edema
The PEEP Effect NEJM 2006;354:1839-1841
Ventilator-induced Lung Injury (VILI) Upper Deflection point Lower Inflection point
[object Object],Lung-Protective Ventilation NEJM 2000; 342: 1301-1308 39.8% 31.0% Result (p<0.001) 9.1 8.1 Actual PEEP Protocol Protocol PEEP <50 <30 P plateau 12 6 Tidal Volume (ml/kg) Conventional ventilation Lung-protective ventilation 18-24 14-18 14 10-14 10 8-10 5-8 5 PEEP 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 FiO2 Principle for FiO2 and PEEP Adjustment
[object Object],[object Object],[object Object],Lung-Protective Ventilation NEJM 2000; 342: 1301-1308
Concerns when using lung-protective strategy
 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other Ventilator Strategies ,[object Object],[object Object],[object Object]
Lung Recruitment ,[object Object],[object Object],[object Object],NEJM 2007; 354: 1775-1786
Lung Recruitment NEJM 2007; 354: 1775-1786
Lung Recruitment NEJM 2007; 354: 1775-1786
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lung Recruitment Sensitivity : 71% Specificity : 59% NEJM 2007; 354: 1775-1786
[object Object],[object Object],[object Object],[object Object],Lung Recruitment
Prone Position
Prone Position ,[object Object],[object Object],[object Object],[object Object]
Prone Position NEJM 2001;345:568-573
Prone Position NEJM 2001;345:568-573
[object Object],[object Object],[object Object],[object Object],[object Object],Prone Position
High-Frequency Oscillatory Ventilation (HFOV)
HFOV Frequency: 180-600 breaths/min (3-10Hz)
Effect of HFOV on gas exchange in ARDS patients AJRCCM 2002; 166:801-8
Survival difference of ARDS patients treated with HFOV or CMV 30-day: P=0.057 90-day: P=0.078 AJRCCM 2002; 166:801-8
HFOV ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Chest 2007; 131:1907-1916
Adjunctive Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Steroid therapy NEJM 2006;354:1671-1684
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Steroid therapy NEJM 2006;354:1671-1684
Fluid Management NEJM 2006;354:2564-2575
Fluid Management NEJM 2006;354:2564-2575
Fluid Management NEJM 2006;354:2213-24
[object Object],[object Object],[object Object],Fluid Management
Extracorporeal Membrane Oxygenation (ECMO) ,[object Object],[object Object],[object Object]
Nitric Oxide ,[object Object],[object Object],[object Object],[object Object]
Unproven Treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lancet 2007; 369:1553-65
Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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20 patient monitoring
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19 introduction of volumetric capnography
19 introduction of volumetric capnography19 introduction of volumetric capnography
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18 basics of pediatric airway anatomy, physiology and management
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17 capnography part4 non-intubated
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16 capnography part3 intubated
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15 capnography part2 introduction
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14 capnography part1 overview
14 capnography part1 overview14 capnography part1 overview
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13 icu monitoring standards and capnography
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12 mainstream sidestream capnpgraphy
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The management of acute respiratory distress syndrome

Hinweis der Redaktion

  1. Limitations: ç”Ÿç†ćźšçŸ©äžéœ€èŠæš™æș–ć‘Œćžć™šæȻ療 , é†«ćž«ćˆ€èź€æœ‰ć·źç•°
  2. Predisposing: alcoholism, severe sepsis, genetic predisposition Direct or indirect, outcome is similar
  3. äžäž€ćźšæƒłćˆ° , æƒłćˆ°äžäž€ćźšćˆ€æ–·çš„ć‡ș
  4. 侀開構的çŒșæ°§äžæ˜Żć„œçš„é æžŹæŒ‡æš™ , 䜆 severe hypoxia for days ć‰‡æ˜Ż
  5. TNF, IL1,IL8 Tissue factor, plasminogen activator inhibitor 1
  6. èż‘ćčŽé‡èŠè§€ćż” : äžć‡ć‹» , é«”é‡ć€§æ–Œé æœŸ ( ćŻèƒœć€§æ–Œ 20%), ć‘Œćžć™šæœƒć°Žè‡Žć‚·ćźł , é›–ç„¶äž€é–‹ć§‹äžæ˜ŽéĄŻ
  7. taken at the end of inspiration. A=0, B=15, C=15 x3, D= 15*5 F=0*1, G = 0*3, H =0*5
  8. ç”šçš„æ˜Żé æœŸé«”é‡
  9. 盼才支侀氍 mortality 有效的æ–čæł•
  10. é«˜äœŽçš„ćˆ†ç•Œæ˜Ż 9%
  11. 䞍論ć“Ș䞀甄 , éƒœć€§çŽ„æœ‰ 24% 的è‚șç„Ąæł•æ‰“é–‹