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
目的俯卧位通气是治疗急性肺损伤/急性呼吸窘迫综合征(ARDS)的重要方法之一,目前俯卧位通气治疗急性百草枯中毒导致ARDS的报道较少。文中旨在评价俯卧位通气治疗急性百草枯中毒致中重度ARDS的价值。方法回顾性分析2016年1月至2017年12...目的俯卧位通气是治疗急性肺损伤/急性呼吸窘迫综合征(ARDS)的重要方法之一,目前俯卧位通气治疗急性百草枯中毒导致ARDS的报道较少。文中旨在评价俯卧位通气治疗急性百草枯中毒致中重度ARDS的价值。方法回顾性分析2016年1月至2017年12月东部战区总医院急救医学科43例急性百草枯中毒合并中重度ARDS患者的临床资料。以是否行俯卧位通气将患者分为2组:俯卧组(进行俯卧位通气,n=13)、对照组(未进行俯卧位通气,n=30)。统计分析2组患者入科时的性别、年龄、APACHE II评分、血浆百草枯浓度等指标,比较住院前5天的氧合指数、呼吸频率、二氧化碳分压及平均动脉压,同时比较2组患者住院病死率、住院时间、机械通气时间等预后指标。结果第2天,俯卧组患者氧合指数(176±13)、二氧化碳分压[(33.6±4.3) mm Hg]较对照组[(149±18)、(26.3±3.2) mm Hg]明显升高(P<0.05),第3-5天亦明显升高(P<0.05);俯卧组呼吸频率较对照组明显降低(P<0.05)。2组患者的住院病死率、住院时间、机械通气时间、气道意外率等差异均无统计学意义(P>0.05)。结论俯卧位通气用于急性百草枯中毒致中重度ARDS的患者是安全的,改善了该类患者的氧合,但未能改善预后。为俯卧位通气治疗急性百草枯中毒合并ARDS提供了理论依据。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
文摘目的俯卧位通气是治疗急性肺损伤/急性呼吸窘迫综合征(ARDS)的重要方法之一,目前俯卧位通气治疗急性百草枯中毒导致ARDS的报道较少。文中旨在评价俯卧位通气治疗急性百草枯中毒致中重度ARDS的价值。方法回顾性分析2016年1月至2017年12月东部战区总医院急救医学科43例急性百草枯中毒合并中重度ARDS患者的临床资料。以是否行俯卧位通气将患者分为2组:俯卧组(进行俯卧位通气,n=13)、对照组(未进行俯卧位通气,n=30)。统计分析2组患者入科时的性别、年龄、APACHE II评分、血浆百草枯浓度等指标,比较住院前5天的氧合指数、呼吸频率、二氧化碳分压及平均动脉压,同时比较2组患者住院病死率、住院时间、机械通气时间等预后指标。结果第2天,俯卧组患者氧合指数(176±13)、二氧化碳分压[(33.6±4.3) mm Hg]较对照组[(149±18)、(26.3±3.2) mm Hg]明显升高(P<0.05),第3-5天亦明显升高(P<0.05);俯卧组呼吸频率较对照组明显降低(P<0.05)。2组患者的住院病死率、住院时间、机械通气时间、气道意外率等差异均无统计学意义(P>0.05)。结论俯卧位通气用于急性百草枯中毒致中重度ARDS的患者是安全的,改善了该类患者的氧合,但未能改善预后。为俯卧位通气治疗急性百草枯中毒合并ARDS提供了理论依据。
