FIFTY YEARS OF RESEARCH IN ARDS Gas Exchange in Acute Respiratory Distress Syndrome
FIFTY YEARS OF RESEARCH IN ARDS Gas Exchange in Acute Respiratory Distress Syndrome
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DOI：
10.1164/rccm.201610-2156so
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发表时间：
2017-10-15
影响因子：
24.7
通讯作者：
Mercat, Alain
中科院分区：
文献类型：
--
作者：
Radermacher, Peter;Maggiore, Salvatore Maurizio;Mercat, Alain
急性呼吸窘迫综合征(ARDS)的特征是严重的气体交换障碍。低氧血症主要是由于肺内分流，而肺泡死腔增加解释了二氧化碳清除的改变。评估气体交换损害的严重程度是确定综合征的特征和评估其严重程度的必要条件。与血流动力学状态相关的混杂因素可极大地影响肺损伤的严重程度与低氧血症程度之间的关系和/或呼吸机设置对气体交换的影响。除了抢救治疗的情况外，与预防损伤相比，针对ARDS的最佳气体交换已变得不那么优先。对于临床医生来说，一个复杂的问题是理解何时氧合和肺泡通气量的改善与肺损伤的程度或风险较低有关。因此，充分了解ARDS的气体交换机制对于ARDS患者的个体化对症支持是非常必要的。
Acute respiratory distress syndrome (ARDS) is characterized by severe impairment of gas exchange. Hypoxemia is mainly due to intrapulmonary shunt, whereas increased alveolar dead space explains the alteration of CO2 clearance. Assessment of the severity of gas exchange impairment is a requisite for the characterization of the syndrome and the evaluation of its severity. Confounding factors linked to hemodynamic status can greatly influence the relationship between the severity of lung injury and the degree of hypoxemia and/or the effects of ventilator settings on gas exchange. Apart from situations of rescue treatment, targeting optimal gas exchange in ARDS has become less of a priority compared with prevention of injury. A complex question for clinicians is to understand when improvement in oxygenation and alveolar ventilation is related to a lower degree or risk of injury for the lungs. In this regard, a full understanding of gas exchange mechanism in ARDS is imperative for individualized symptomatic support of patients with ARDS.