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The management of acute respiratory distress syndrome
1.
The Management of
Acute Respiratory Distress Syndrome 署立桃園醫院 胸腔內科 林倬睿醫師
2.
3.
4.
5.
6.
7.
8.
NEJM 2000;342:1334-1349
9.
NEJM 2000;342:1334-1349
10.
NEJM 2000;342:1334-1349
11.
12.
13.
Ventilator Strategy
14.
15.
16.
17.
The PEEP Effect
NEJM 2006;354:1839-1841
18.
Ventilator-induced Lung Injury
(VILI) Upper Deflection point Lower Inflection point
19.
20.
21.
22.
23.
24.
Lung Recruitment NEJM
2007; 354: 1775-1786
25.
Lung Recruitment NEJM
2007; 354: 1775-1786
26.
27.
28.
Prone Position
29.
30.
Prone Position NEJM
2001;345:568-573
31.
Prone Position NEJM
2001;345:568-573
32.
33.
High-Frequency Oscillatory Ventilation
(HFOV)
34.
HFOV Frequency: 180-600
breaths/min (3-10Hz)
35.
Effect of HFOV
on gas exchange in ARDS patients AJRCCM 2002; 166:801-8
36.
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
37.
38.
39.
Steroid therapy NEJM
2006;354:1671-1684
40.
41.
Fluid Management NEJM
2006;354:2564-2575
42.
Fluid Management NEJM
2006;354:2564-2575
43.
Fluid Management NEJM
2006;354:2213-24
44.
45.
46.
47.
48.
Notes de l'éditeur
Limitations: 生理定義不需要標準呼吸器治療 , 醫師判讀有差異
Predisposing: alcoholism, severe sepsis, genetic predisposition Direct or indirect, outcome is similar
不一定想到 , 想到不一定判斷的出
一開始的缺氧不是好的預測指標 , 但 severe hypoxia for days 則是
TNF, IL1,IL8 Tissue factor, plasminogen activator inhibitor 1
近年重要觀念 : 不均勻 , 體重大於預期 ( 可能大於 20%), 呼吸器會導致傷害 , 雖然一開始不明顯
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
用的是預期體重
目前唯一對 mortality 有效的方法
高低的分界是 9%
不論哪一組 , 都大約有 24% 的肺無法打開
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