#ARDS的新定義
The definition of ARDS revisited: 20 years later
For all of the improvements brought by the new ARDS definition, problems remain. Most frustrating is the lack of a biomarker (clinical laboratory test) that can be used to make the diagnosis. Even groups of biomarkers combining clinically available measures with the latest research-generated biomarkers, though promising, have not been compelling enough to be moved into clinical practice. We still cannot readily measure permeability which is often considered the hallmark of ARDS. The role of hydrostatic pressure remains a major confounder and is not readily clarified by the use of echocardiograms or CT scans. Perhaps tools that hold potential for diagnosing increased lung water and/or permeability may take hold clinically. Particularly important would be development of tools/criteria that may even be able to reliably predict development of ARDS.
ards definition 在 加護病房查房日誌 Facebook 的最佳解答
加護病房查房日誌20151026-呼吸治療師篇
老師今天請了一位專業的呼吸治療師,來幫大家上呼吸器的課程,未來也會不定期的請他來上課,希望帶給大家不同領域專業的解說。希望大家會喜歡。
ARDS在呼吸器方面的設定
ARDS病患在臨床使用呼吸器時常常會有幾個情況產生, (1)高的氣道壓力, 可能是肺部低順應性(Complaince)所導致 , (2)嚴重的低血氧或是高碳酸血症, 可能是肺部浸潤嚴重所導致的氣體交換及氧合不足所導致.
呼吸器設定方面, ARDS病患我們在臨床都把握幾個原則.像是肺保護策略 以及 肺擴張策略
肺保護策略
較低的潮氣容積及適當的吐氣末陽壓是現今對於ARDS患者所採取的一種肺保護策略, 臨床多以每公斤體重給與4-6毫 升的方式來設定較低的潮氣容積, 至於最適當 的吐氣末陽壓則需考慮壓力及氧氣濃度的設定而定。
肺擴張策略
在臨床及學理上肺擴張策略的方式有很多種, 像是漸進式增加氣道正壓或是直接使用高氣道正壓持續40秒的方式去試著打開塌陷的肺泡來改善氣體交換, 也可以去減少肺損傷的問題發生。
參考文獻
AMA. 2012;307(23):2526-2533. doi:10.1001/jama.2012.5669.
Acute Respiratory Distress SyndromeThe Berlin Definition
Critical Care Medicine.2003 Apr;31(4 Suppl):S265-71.
Lung recruitment maneuvers in acute respiratory distress syndrome and facilitating resolution.
Critical Care Medicine.November 26, 2013 Ventilator-Induced Lung Injury
Simon Finfer, M.D., and Jean-Louis Vincent, M.D., Ph.D.,Editors,
ards definition 在 ARDS Definition (Acute Respiratory Distress Syndrome) 的推薦與評價
ARDS Definition (Acute Respiratory Distress Syndrome) · https://bit.ly/2ZuAmd2 ➡️ ARDS stands for: Acute Respiratory Distress Syndrome. · https ... ... <看更多>