Current Concepts of ARDS: A Narrative Review.
Current Concepts of ARDS: A Narrative Review.
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DOI：
10.3390/ijms18010064
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发表时间：
2016-12-29
影响因子：
5.6
通讯作者：
Chiumello D
中科院分区：
文献类型：
--
作者：
Umbrello M;Formenti P;Bolgiaghi L;Chiumello D
急性呼吸窘迫综合征（ARDS）的特点是急性发作的非心源性肺水肿，同时伴有双侧肺浸润和呼吸系统顺应性降低。该综合征的标志是难治性低氧血症。尽管它的第一个描述可以追溯到20世纪70年代末，但最近提出了一个新的定义。然而，定义仍然基于临床特征。在目前的审查，诊断工作和病理生理综合征将提出。将回顾ARDS的治疗方法，包括肺保护性通气、俯卧位、神经肌肉阻断、吸入血管扩张剂、皮质类固醇和招募演习。我们将强调如何为ARDS患者提供呼吸和血流动力学支持的整体框架，旨在通过促进肺补充来确保足够的气体交换，同时最大限度地降低呼吸机引起的肺损伤的风险。为此，应考虑肺部的可招募性，并通过监测经肺压或气道驱动压来避免肺部过度应激。在最严重的情况下，应考虑神经肌肉阻滞、俯卧位和体外生命支持（单独或联合）。
Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of pulmonary edema of non-cardiogenic origin, along with bilateral pulmonary infiltrates and reduction in respiratory system compliance. The hallmark of the syndrome is refractory hypoxemia. Despite its first description dates back in the late 1970s, a new definition has recently been proposed. However, the definition remains based on clinical characteristic. In the present review, the diagnostic workup and the pathophysiology of the syndrome will be presented. Therapeutic approaches to ARDS, including lung protective ventilation, prone positioning, neuromuscular blockade, inhaled vasodilators, corticosteroids and recruitment manoeuvres will be reviewed. We will underline how a holistic framework of respiratory and hemodynamic support should be provided to patients with ARDS, aiming to ensure adequate gas exchange by promoting lung recruitment while minimizing the risk of ventilator-induced lung injury. To do so, lung recruitability should be considered, as well as the avoidance of lung overstress by monitoring transpulmonary pressure or airway driving pressure. In the most severe cases, neuromuscular blockade, prone positioning, and extra-corporeal life support (alone or in combination) should be taken into account.