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ID:37970150
大小:17.72 KB
页数:4页
时间:2019-06-04
《2013脓毒血症ARDS机械通气指南》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、MechanicalVentilationinARDSDuetoSepsisSeeAlltheSurvivingSepsisGuidelinesSepsisisoneofthemaincausesofacuterespiratorydistresssyndrome(ARDS),inwhichthelungsareinjuredbycirculatinginflammatorymediators,resultinginseverelyimpairedgasexchangeusuallyrequiringinvasivemechanicalventilation.ARDSalsoresu
2、ltsinpoorlungcomplianceinahetereogeneousdistribution,makingless-affectedlungareasmorevulnerabletoventilator-inducedlunginjury.Sepsis-inducedARDSisaformofsevereorganfailure,andisamajorcontributortothehighmortalityfromseveresepsisandsepticshock.Sepsis-inducedARDSmostoftenresultsfrompneumonia,butA
3、RDScandevelopasasequelafromsepsisofanyinfectioussource.MechanicalventilationinARDShasbeenexaminedinnumerouswell-conductedrandomizedcontrolledtrials,mostofwhichincludedpatientswithseveresepsisandsepticshock.Onlyahandfulofstudieshaveconsideredsepsis-inducedARDSasadistinctentity;mostoftheevidences
4、upportingtheSurvivingSepsisGuidelinesformechanicalventilationinsepsis-inducedARDSderivefromevidencecollectedinARDStrialsingeneral.TheSurvivingSepsisGuidelinesformechanicalventilationofARDSduetosepsisdon'tdivergesignificantlyfromthegeneralmanagementofARDS;hereisasummary.LowTidalVolumeVentilation
5、forSepsis-InducedARDSTraditionalhightidalvolumes(10-12mL/kg)providedduringmechanicalventilationcancausebarotraumaandareharmfultopeoplewithARDS.Uselowtidalvolumesof6mL/kgofpredictedbodyweightforpeoplewithsepsis-inducedARDS(orfromanycause).(Strength:Grade1A,ascomparedagainst12mL/kg).Predictedbody
6、weightiscalculatedbyheight;useanonlinechartorcalculatortohelpyou.A5'9"manwouldreceive424mLtidalvolumes;a5'3"woman,only314mL.Theseuncomfortably-low-seemingvaluesmaybepartlywhyphysicianscommonlyuseinappropriatelyhightidalvolumesinARDS;it'sbeensuggestedthatwomenwithARDSareespeciallylikelytoreceive
7、excessivetidalvolumes.TheplateaupressureinpeoplewithARDSshouldbemeasuredandideallymaintained≤30cmH2Owithpassiveinflationofthelungsduringmechanicalventilation(Grade1B).Ifplateaupressures≤30cmH2Ocan'tbeachievedwith6mL/kgtidalvolumes
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