Acute Respiratory Distress Syndrome in the Perioperative Period of Cardiac Surgery: Predictors, Diagnosis, Prognosis, Management Options, and Future Directions.
Acute Respiratory Distress Syndrome in the Perioperative Period of Cardiac Surgery: Predictors, Diagnosis, Prognosis, Management Options, and Future Directions.
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DOI：
10.1053/j.jvca.2021.04.024
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发表时间：
2022-04
影响因子：
2.8
通讯作者：
Astuto M
中科院分区：
文献类型：
--
作者：
Sanfilippo F;Palumbo GJ;Bignami E;Pavesi M;Ranucci M;Scolletta S;Pelosi P;Astuto M
心脏手术后急性呼吸窘迫综合征（ARDS）的发病率有很大差异（0.4%-8.1%）。心脏外科手术患者常合并多种疾病，ARDS的发生严重影响其预后。在此，证据有关的心脏外科手术中的ARDS领域的现有知识进行了总结，其次是治疗策略的讨论，考虑到心脏手术后的ARDS的特殊方面。预防心脏手术期间和之后的肺损伤仍然至关重要。应限制血液制品输注，以尽量减少肺损伤等风险。开放肺通气策略（心肺转流期间通气、肺复张操作和使用中度呼气末正压）未显示出对临床结局的明显获益。临床医生在术中和术后急救时应仔细考虑机械通气对心功能（特别是右心室）的影响。驱动压力应保持尽可能低，潮气量（根据预测体重）和最佳呼气末正压。关于治疗选择，心脏手术后ARDS的管理挑战了常规方法。例如，心脏手术后可能不容易应用俯卧位。在心脏手术后发生ARDS的患者中，体外技术可能是有经验的医生的有效选择。神经肌肉阻滞和吸入性一氧化氮的使用可根据具体情况考虑，而积极肺复张和振荡通气的使用应被劝阻。
Acute respiratory distress syndrome (ARDS) after cardiac surgery is reported with a widely variable incidence (from 0.4%-8.1%). Cardiac surgery patients usually are affected by several comorbidities, and the development of ARDS significantly affects their prognosis. Herein, evidence regarding the current knowledge in the field of ARDS in cardiac surgery is summarized and is followed by a discussion on therapeutic strategies, with consideration of the peculiar aspects of ARDS after cardiac surgery. Prevention of lung injury during and after cardiac surgery remains pivotal. Blood product transfusions should be limited to minimize the risk, among others, of lung injury. Open lung ventilation strategy (ventilation during cardiopulmonary bypass, recruitment maneuvers, and the use of moderate positive end-expiratory pressure) has not shown clear benefits on clinical outcomes. Clinicians in the intraoperative and postoperative ventilatory settings carefully should consider the effect of mechanical ventilation on cardiac function (in particular the right ventricle). Driving pressure should be kept as low as possible, with low tidal volumes (on predicted body weight) and optimal positive end-expiratory pressure. Regarding the therapeutic options, management of ARDS after cardiac surgery challenges the common approach. For instance, prone positioning may not be easily applicable after cardiac surgery. In patients who develop ARDS after cardiac surgery, extracorporeal techniques may be a valid choice in experienced hands. The use of neuromuscular blockade and inhaled nitric oxide can be considered on a case-by-case basis, whereas the use of aggressive lung recruitment and oscillatory ventilation should be discouraged.
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DOI：
10.1053/j.jvca.2010.09.002
发表时间：
2011-10-01
影响因子：
2.8
作者：
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