Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the c...Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve . Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended . The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evidence-based 展开更多
重症监护病房（intensive care unit ，ICU ）机械通气患者普遍存在营养不良，而早期肠内营养可防治感染和代谢并发症，保护肠道黏膜屏障功能，阻止细菌和内毒素移位，因此日益受到重视［1-2］。但肠内营养容易出现胃潴留、反流、误吸...重症监护病房（intensive care unit ，ICU ）机械通气患者普遍存在营养不良，而早期肠内营养可防治感染和代谢并发症，保护肠道黏膜屏障功能，阻止细菌和内毒素移位，因此日益受到重视［1-2］。但肠内营养容易出现胃潴留、反流、误吸、腹泻等并发症，成为影响患者病情的重要因素。为此，2012年1～12月，本文对106例机械通气患者在肠内营养实施过程中采用循证护理进行干预，取得满意效果，现报道如下。展开更多
文摘Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve . Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended . The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evidence-based
文摘重症监护病房（intensive care unit ，ICU ）机械通气患者普遍存在营养不良，而早期肠内营养可防治感染和代谢并发症，保护肠道黏膜屏障功能，阻止细菌和内毒素移位，因此日益受到重视［1-2］。但肠内营养容易出现胃潴留、反流、误吸、腹泻等并发症，成为影响患者病情的重要因素。为此，2012年1～12月，本文对106例机械通气患者在肠内营养实施过程中采用循证护理进行干预，取得满意效果，现报道如下。
