The Role of Ventilation-induced Surfactant Dysfunction and Atelectasis in Causing Acute Respiratory Distress Syndrome
The Role of Ventilation-induced Surfactant Dysfunction and Atelectasis in Causing Acute Respiratory Distress Syndrome
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DOI：
10.1164/rccm.201109-1667pp
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发表时间：
2012-04-01
影响因子：
24.7
通讯作者：
Albert, Richard K.
中科院分区：
文献类型：
--
作者：
Albert, Richard K.
肺的角度描述了一种新的病理生理情况下，急性呼吸窘迫综合征（ARDS）可能会发展，总结了文献，这种新的情况下，并讨论了由此产生的影响，病人的管理。不是由于与诱发危险因素相关的炎症反应而发生ARDS，而是提出的方案理论上认为，最初的问题是由于自发或机械通气引起的表面活性物质异常以及我们目前对患者定位和镇静的方法导致的肺不张。提出的病理生理学意味着通气诱导的肺损伤发生在ARDS之前并导致ARDS（而不是在事实发生后发展，仅用于放大现有的损伤），并且某些ARDS病例是医源性的。如果所提出的方案是正确的，它也意味着，至少有一些情况下的ARDS可能会防止实施一些简单的，安全的修改病人护理。
This Pulmonary Perspective describes a new pathophysiologic scenario by which the acute respiratory distress syndrome (ARDS) might develop, summarizes the literature on which this new scenario is based, and discusses the resulting implications with respect to patient management. Rather than ARDS occurring as a result of the inflammatory response associated with predisposing risk factors, the proposed scenario theorizes that the initiating problem is atelectasis that develops as a result of a surfactant abnormality that is caused by spontaneous or mechanical ventilation, together with our current approaches to patient positioning and sedation. The proposed pathophysiology implies that ventilation-induced lung injury occurs before, and causes, ARDS (rather than developing after the fact and only serving to magnify the existing injury) and that some instances of ARDS are iatrogenic. If the proposed scenario is correct, it also implies that at least some instances of ARDS might be prevented by implementing a number of simple, safe modifications in patient care.