• 【更正: 在ARDS幸存者中筛查创伤后应激障碍: 事件量表6影响的验证 (IES-6)。】 复制标题 收藏 收藏
    DOI:10.1186/s13054-020-2759-0 复制DOI
    作者列表:Hosey MM,Leoutsakos JS,Li X,Dinglas VD,Bienvenu OJ,Parker AM,Hopkins RO,Needham DM,Neufeld KJ
    BACKGROUND & AIMS: :In the publication of this article [1], there is an error in the Abstract. This has now been included in this correction article.
    背景与目标: : 在本文 [1] 的发布中,摘要中有错误。这现在已经包含在这篇更正文章中。
  • 【皮质类固醇治疗对流感相关性ARDS临床结局的影响: 一项全国性多中心研究.】 复制标题 收藏 收藏
    DOI:10.1186/s13613-020-0642-4 复制DOI
    作者列表:Tsai MJ,Yang KY,Chan MC,Kao KC,Wang HC,Perng WC,Wu CL,Liang SJ,Fang WF,Tsai JR,Chang WA,Chien YC,Chen WC,Hu HC,Lin CY,Chao WC,Sheu CC,for Taiwan Severe Influenza Research Consortium (TSIRC) Investigators.
    BACKGROUND & AIMS: BACKGROUND:Corticosteroid treatment has been widely used in the treatment of septic shock, influenza, and ARDS, although some previous studies discourage its use in severe influenza patients. This multicenter retrospective cohort study conducted in the intensive care units (ICUs) of eight medical centers across Taiwan aims to determine the real-world status of corticosteroid treatment in patients with influenza-associated acute respiratory distress syndrome (ARDS) and its impact on clinical outcomes. Between October 2015 and March 2016, consecutive ICU patients with virology-proven influenza infections who fulfilled ARDS and received invasive mechanical ventilation were enrolled. The impact of early corticosteroid treatment (≥ 200 mg hydrocortisone equivalent dose within 3 days after ICU admission, determined by a sensitivity analysis) on hospital mortality (the primary outcome) was assessed by multivariable logistic regression analysis, and further confirmed in a propensity score-matched cohort. RESULTS:Among the 241 patients with influenza-associated ARDS, 85 (35.3%) patients receiving early corticosteroid treatment had similar baseline characteristics, but a significantly higher hospital mortality rate than those without early corticosteroid treatment [43.5% (37/85) vs. 19.2% (30/156), p < 0.001]. Early corticosteroid treatment was independently associated with increased hospital mortality in overall patients [adjusted odds ratio (95% CI) = 5.02 (2.39-10.54), p < 0.001] and in all subgroups. Earlier treatment and higher dosing were associated with higher hospital mortality. Early corticosteroid treatment was associated with a significantly increased odds of subsequent bacteremia [adjusted odds ratio (95% CI) = 2.37 (1.01-5.56)]. The analyses using a propensity score-matched cohort showed consistent results. CONCLUSIONS:Early corticosteroid treatment was associated with a significantly increased hospital mortality in adult patients with influenza-associated ARDS. Earlier treatment and higher dosing were associated with higher hospital mortality. Clinicians should be cautious while using corticosteroid treatment in this patient group.
    背景与目标:
  • 【ARDS和体外膜氧合患者致命的播散性真菌性败血症的病例报告。】 复制标题 收藏 收藏
    DOI:10.1186/s12871-020-01031-9 复制DOI
    作者列表:Prohaska S,Henn P,Wenz S,Frauenfeld L,Rosenberger P,Haeberle HA
    BACKGROUND & AIMS: BACKGROUND:With the following report we want to present an unusual case of a patient suffering from acute respiratory distress syndrome with early discovery of bacterial pathogens in bronchoalveolar liquid samples that developed a fatal undiscovered disseminated fungal infection. CASE PRESENTATION:A 67-year-old man was admitted to our university hospital with dyspnea. Progressive respiratory failure developed leading to admission to the intensive care unit, intubation and prone positioning was necessary. To ensure adequate oxygenation and lung protective ventilation veno-venous extracorporeal membrane oxygenation was established. Despite maximal therapy and adequate antiinfective therapy of all discovered pathogens the condition of the patient declined further and he deceased. Postmortem autopsy revealed Mucor and Aspergillus mycelium in multiple organs such as lung, heart and pancreas as the underlying cause of his deterioration and death. CONCLUSION:Routine screening re-evaluation of every infection is essential for adequate initiation and discontinuation of every antiinfective therapy. In cases with unexplained deterioration and unsuccessful sampling the possibility for diagnostic biopsies should be considered.
    背景与目标:
  • 【延长俯卧位疗程对ARDS的血流动力学影响。】 复制标题 收藏 收藏
    DOI:10.1186/s13613-018-0464-9 复制DOI
    作者列表:Ruste M,Bitker L,Yonis H,Riad Z,Louf-Durier A,Lissonde F,Perinel-Ragey S,Guerin C,Richard JC
    BACKGROUND & AIMS: BACKGROUND:Hemodynamic response to prone position (PP) has never been studied in a large series of patients with acute respiratory distress syndrome (ARDS). The primary aim of this study was to estimate the rate of PP sessions associated with cardiac index improvement. Secondary objective was to describe hemodynamic response to PP and during the shift from PP to supine position. METHODS:The study was a single-center retrospective observational study, performed on ARDS patients, undergoing at least one PP session under monitoring by transpulmonary thermodilution. PP sessions performed more than 10 days after ARDS onset, or with any missing cardiac index measurements before (T1), at the end (T3), and after the PP session (T4) were excluded. Changes in hemodynamic parameters during PP were tested after statistical adjustment for volume of fluid challenges, vasopressor and dobutamine dose at each time point to take into account therapeutic changes during PP sessions. RESULTS:In total, 107 patients fulfilled the inclusion criteria, totalizing 197 PP sessions. Changes in cardiac index between T1 and T2 (early response to PP) and between T1 and T3 (late response to PP) were significantly correlated (R2 = 0.42, p < 0.001) with a concordance rate amounting to 85%. Cardiac index increased significantly between T1 and T3 in 49 sessions (25% [95% confidence interval (CI95%) 18-32%]), decreased significantly in 46 (23% [CI95% 16-31%]), and remained stable in 102 (52% [CI95% 45-59%]). Global end-diastolic volume index (GEDVI) increased slightly but significantly from 719 ± 193 mL m-2 at T1 to 757 ± 209 mL m-2 at T3 and returned to baseline values at T4. Cardiac index and oxygen delivery decreased slightly but significantly from T3 to T4, without detectable increase in lactate level. Patients who increased their cardiac index during PP had significantly lower CI, GEDVI, global ejection fraction at T1, and received significantly more fluids than patients who did not. CONCLUSION:PP is associated with an increase in cardiac index in 18% to 32% of all PP sessions and a sustained increase in GEDVI reversible after return to supine position. Return from prone to supine position is associated with a slight hemodynamic impairment.
    背景与目标:
  • 【成人呼吸窘迫综合征 (ARDS) 与胸部照射 (RT) 的关系。】 复制标题 收藏 收藏
    DOI:10.1016/0360-3016(88)90241-6 复制DOI
    作者列表:Byhardt RW,Abrams R,Almagro U
    BACKGROUND & AIMS: :The authors report two cases of apparent adult respiratory distress syndrome (ARDS) following limited thoracic irradiation for lung cancer. Respiratory failure followed rapidly after irradiation with diffuse bilateral infiltrates, both in and out of the irradiated volume along with progressive hypoxemia unresponsive to oxygen management. Other potential causes of lung injury such as lymphangitic tumor, cardiac failure, and infections were excluded by both premortem and postmortem examination. Autopsy findings in both irradiated and unirradiated volumes of lung were consistent with hyaline membrane changes. The possible relationship between radiation therapy to limited lung volumes and the development of adult respiratory distress syndrome is discussed.
    背景与目标: : 作者报告了2例肺癌胸腔照射后明显的成人呼吸窘迫综合征 (ARDS)。在照射后,弥漫性双侧浸润迅速出现呼吸衰竭,无论是在照射体积内还是在照射体积外,以及对氧气管理无反应的进行性低氧血症。死前和死后检查均排除了其他潜在的肺损伤原因,例如淋巴管肿瘤,心力衰竭和感染。辐照和未辐照肺的尸检结果均与透明膜变化一致。讨论了放射治疗对有限的肺体积与成人呼吸窘迫综合征的发展之间的可能关系。
  • 【15岁患者烧伤和吸入性损伤后严重ARDS并伴有五器官系统衰竭的生存。】 复制标题 收藏 收藏
    DOI:10.1016/s0305-4179(03)00010-x 复制DOI
    作者列表:Cedidi C,Hierner R,Pichlmaier M,Forssmann WG,Meyer M
    BACKGROUND & AIMS: OBJECTIVE:To show the effectiveness of an integrated therapeutical approach in a severe case of acute respiratory distress syndrome (ARDS) following burns, inhalation injury with therapy-refractory oxygenation under maximized ventilatory settings, and an overall complicated clinical course. PATIENT AND METHODS:Case report of a patient with severe inhalation injury and burns in an intensive care unit setting, undergoing cardiopulmonary resuscitation (CPR), nitric oxide (NO)-inhalation, surfactant-, kinetic-, and urodilatin-therapy. CASE REPORT:A 15-year-old male presented with deep dermal and full thickness thermal injuries involving 25% of his total body surface area. Shortly after presentation, the patient developed therapy-refractory respiratory failure, cardiac arrest, and subsequently suffered five-organ system failure (lung, heart, gastrointestinal, liver, kidney), in addition to burn injury, and ischemia related cerebral lesions. The patient was successfully treated with cardiac resuscitation, extra corporeal membrane oxygenation (ECMO), NO, kinetic therapy, surfactant, urodilatin, and other standard intensive care regimens. Three months post-trauma the patient was discharged home, nearly fully recovered. CONCLUSIONS:In a patient with severe ARDS, oxygenation failure under maximized ventilatory settings, and subsequent five-organ system failure, an integrated therapeutical approach comprising ECMO, NO, kinetic therapy, surfactant, and urodilatin did cross-bridge respiratory and vital functions, enabling overall survival.
    背景与目标:
  • 【严重低氧血症的ARDS患者的生存率增加 (ECMO标准)。】 复制标题 收藏 收藏
    DOI:10.1378/chest.99.4.951 复制DOI
    作者列表:Suchyta MR,Clemmer TP,Orme JF Jr,Morris AH,Elliott CG
    BACKGROUND & AIMS: :The adult respiratory distress syndrome (ARDS) is a form of diffuse lung injury associated with multiple risk factors. Patients with severe hypoxemia who meet blood gas criteria defined by the extracorporeal membrane oxygenation trial (ECMO) of 1974 to 1977 have a reported survival of 11 percent. The reported survival has remained unchanged for 15 years despite numerous technologic advances. We prospectively studied ARDS patients who met ECMO blood gas criteria. One hundred seventy-eight ARDS patients were prospectively screened over a 30-month period. Fifty-one of these patients met ECMO blood gas criteria and 23 (45 percent) survived (p less than 0.001 vs ECMO trial). No obvious differences in etiology, APACHE II score, organ system failure, or the incidence of sepsis was found between survivors and nonsurvivors. We conclude that survival of ARDS patients who met ECMO blood gas criteria in our institution is higher than that previously reported from both other centers and our own hospital.
    背景与目标: : 成人呼吸窘迫综合征 (ARDS) 是一种与多种危险因素相关的弥漫性肺损伤。符合体外膜氧合试验 (ECMO) 1974年定义的血气标准的严重低氧血症患者1977年的生存率为11%。尽管有许多技术进步,但报告的生存率仍保持15年不变。我们前瞻性地研究了符合ECMO血气标准的ARDS患者。在30个月的时间内,对78名ARDS患者进行了前瞻性筛查。这些患者中有51名符合ECMO血气标准,23名 (45% 名) 存活 (与ECMO试验相比,p小于0.001)。幸存者和非幸存者在病因,APACHE II评分,器官系统衰竭或败血症发生率方面没有明显差异。我们得出的结论是,在我们机构中符合ECMO血气标准的ARDS患者的生存率高于其他中心和我们自己的医院先前报告的生存率。
  • 【伊洛前列素治疗急性呼吸窘迫综合征 (ARDS) (ThIlo试验): 一项前瞻性,随机,多中心II期研究。】 复制标题 收藏 收藏
    DOI:10.1186/s13063-020-4163-0 复制DOI
    作者列表:Haeberle H,Prohaska S,Martus P,Straub A,Zarbock A,Marx G,Zago M,Giera M,Koeppen M,Rosenberger P
    BACKGROUND & AIMS: BACKGROUND:Acute respiratory distress syndrome (ARDS) is caused by rapid-onset (within hours) acute inflammatory processes in lung tissue, and it is a life-threatening condition with high mortality. The treatment of ARDS to date is focused on the prevention of further iatrogenic damage of the lung rather than the treatment of the initial inflammatory process. Several preclinical studies have revealed a beneficial effect of iloprost on the control of pulmonary inflammation, and in a small number of patients with ARDS, iloprost treatment resulted in improved oxygenation. Therefore, we plan to conduct a large multicenter trial to evaluate the effect of iloprost on ARDS. METHODS:The Therapeutic Iloprost during ARDS trial (ThIlo trial) is a multicenter, randomized, single blinded, clinical phase II trial assessing the efficacy of inhaled iloprost for the prevention of the development and progression of ARDS in critically ill patients. One hundred fifty critically ill patients suffering from acute ARDS will be treated either by nebulized iloprost or NaCl 0.9% for 5 days. Blood samples will be drawn at defined time points to elucidate the serum levels of iloprost and inflammatory markers during treatment. Mechanical ventilation will be standardized. In follow-up visits at days 28 and 90 as well as 6 months after enrollment, functional status according to the Barthel Index and a health care-related questionnaire, and frailty (Vulnerable Elders Survey) will be evaluated. The primary endpoint is the improvement of oxygenation, defined as the ratio of PaO2/FiO2. Secondary endpoints include 90-day all-cause mortality, Sequential Organ Failure Assessment scores during the study period up to day 90, the duration of mechanical ventilation, the length of intensive care unit (ICU) stay, ventilator-associated pneumonia, delirium, ICU-acquired weakness, and discharge localization. The study will be conducted in three university ARDS centers in Germany. DISCUSSION:The results of the ThIlo trial will highlight the anti-inflammatory effect of iloprost on early inflammatory processes during ARDS, resulting in the improvement of outcome parameters in patients with ARDS. TRIAL REGISTRATION:EUDRA-CT: 2016-003168-37. Registered on 12 April 2017. ClinicalTrials.gov: NCT03111212. Registered on 4 June 2017.
    背景与目标:
  • 9 [ARDS--an update]. 复制标题 收藏 收藏

    【[ARDS-更新]。】 复制标题 收藏 收藏
    DOI:10.1055/s-0032-1333051 复制DOI
    作者列表:Braune S,Kluge S
    BACKGROUND & AIMS: :The acute respiratory distress syndrome (ARDS) is characterized by severe impairment of gas exchange and remains a challenge for modern intensive care medicine. The most common causes of ARDS are pneumonia and sepsis. The mortality in severe ARDS is as high as 50 %. The new definition of ARDS differentiates three levels of severity depending on the degree of hypoxaemia. The fundamental basis of therapy is to treat the underlying cause of ARDS. Furthermore, lung protective mechanical ventilation must be applied using low tidal volumes and limiting inspiratory pressures. Intermittent prone positioning can reduce mortality in severe cases of ARDS. In extreme, life threatening cases extracorporeal membrane oxygenation can stabilize gas exchange and serve as a bridge to recovery and means to enable lung protective ventilation.
    背景与目标: : 急性呼吸窘迫综合征 (ARDS) 的特点是气体交换严重受损,仍然是现代重症监护医学的挑战。ARDS最常见的原因是肺炎和败血症。严重ARDS的死亡率高达50%。ARDS的新定义根据低氧血症的程度区分了三个严重程度。治疗的根本基础是治疗ARDS的根本原因。此外,必须使用低潮气量和限制吸气压力进行肺保护性机械通气。间歇性俯卧定位可以降低严重ARDS病例的死亡率。在极端情况下,危及生命的情况下,体外膜氧合可以稳定气体交换,并作为恢复的桥梁和实现肺保护性通气的手段。
  • 【ALI/ARDS期间表面活性剂治疗的未来。】 复制标题 收藏 收藏
    DOI:10.1055/s-2006-948291 复制DOI
    作者列表:Lewis JF,Veldhuizen RA
    BACKGROUND & AIMS: :The importance of pulmonary surfactant in maintaining normal lung function, and the observations that alterations in endogenous surfactant contribute to the lung dysfunction associated with acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS), provide a rationale for administering exogenous surfactant in this setting. The results of clinical trials have been variable, however, in part due to the various surfactant preparations used, the different delivery and dosing methods employed, and the types of patients targeted for this therapy. Based on the insight gained from these studies, ongoing trials have modified these factors to optimize outcome, including one trial that is focusing on patients with direct lung insults such as pneumonia and aspiration. The future of surfactant therapy may well take advantage of the recently described host defense functions of this material. Based on extensive in vitro data as well as in vivo animal studies demonstrating the anti-inflammatory and antibacterial functions of various surfactant components, administration of surfactant earlier in the course of the disease, when lung inflammation is present but before severe lung dysfunction occurs, may prove to be optimal. This review discusses both the biophysical and host defense functions of surfactant in the context of novel therapeutic approaches for patients with ALI/ARDS.
    背景与目标: : 肺表面活性剂在维持正常肺功能中的重要性,以及内源性表面活性剂的改变导致与急性肺损伤 (ALI) 和急性呼吸窘迫综合征 (ARDS) 相关的肺功能障碍的观察结果,为在这种情况下施用外源性表面活性剂提供了依据。但是,临床试验的结果是可变的,部分原因是所使用的各种表面活性剂制剂,所采用的不同给药和给药方法以及针对该疗法的患者类型。基于从这些研究中获得的见解,正在进行的试验已经修改了这些因素以优化结果,其中包括一项针对患有直接肺损伤 (如肺炎和误吸) 的患者的试验。表面活性剂疗法的未来很可能会利用这种材料最近描述的宿主防御功能。基于广泛的体外数据以及体内动物研究,证明了各种表面活性剂成分的抗炎和抗菌功能,在疾病过程中,当存在肺部炎症时,但在严重的肺部功能障碍发生之前,可以证明是最佳的。本文在针对ALI/ARDS患者的新型治疗方法的背景下讨论了表面活性剂的生物物理和宿主防御功能。
  • 【院前抗血小板治疗对ARDS发生率的影响。】 复制标题 收藏 收藏
    DOI:10.4187/respcare.07177 复制DOI
    作者列表:Jin W,Chuang CC,Jin H,Ye J,Kandaswamy E,Wang L,Zuo L
    BACKGROUND & AIMS: BACKGROUND:Clinical observations on the potential of pre-hospital antiplatelet therapy in preventing ARDS have been inconsistent. To further the correlation between antiplatelet therapy and ARDS, we conducted a meta-analysis to evaluate the effects of pre-hospital antiplatelet therapy on subjects with ARDS. METHODS:A literature search in major data banks was performed. We included prospective and retrospective cohorts, case-control trials, and randomized controlled trials that compared the ARDS incidence in subjects with or without pre-hospital antiplatelet agents. RESULTS:Meta-analysis of 7 studies (a total of 30,291 subjects) showed significantly lower odds of ARDS in the pre-hospital antiplatelet therapy group compared with subjects with no pre-hospital antiplatelet therapy (odds ratio 0.68, 95% CI 0.56-0.83; P < .001). However, ARDS mortalities in the hospital and ICUs were not affected. CONCLUSIONS:These findings indicated that pre-hospital antiplatelet therapy was associated with a reduced rate of ARDS but had no effect on the mortality in the subjects at high risk.
    背景与目标:
  • 【特发性成人呼吸窘迫综合征 (ARDS)/弥漫性肺泡损伤 (DAD) 的诊断影像学与放射学的相关性。】 复制标题 收藏 收藏
    DOI:10.1016/0899-7071(94)00057-3 复制DOI
    作者列表:Kobayashi H,Itoh T,Sasaki Y,Konishi J
    BACKGROUND & AIMS: :In ten patients with idiopathic adult respiratory distress syndrome (ARDS) who had histopathologically diffuse alveolar damage (DAD), and who did not have specific underlying diseases, we compared the histopathological findings with their radiographic images in order to study the detail analysis of radiographic images and the clinical courses. These patients were roughly classified as having the interstitial pneumonia dominant type (type IP) of idiopathic ARDS, in which alveolar septal thickening, alveolitis, or both were the predominant histological findings and images showed increasing attenuation of lung fields with small honeycomb lung, or the organizing pneumonia dominant type (type OP), in which organizing exudate predominantly filled the alveoli histologically and images showed consolidation shadows with some air. Hyaline membrane was seen very frequently in patients with a short clinical course, and in accordance with a longer clinical course, widespread fibrosis and honeycomb lung covered by organizing hyaline membrane was seen with both types. Patients with type OP in whom collapse of the normal pulmonary structure was less and for whom changes on radiographic images were larger seemed to respond relatively favorably to steroid treatment, as judged from pulmonary function and radiographic images.
    背景与目标: : 在十名患有组织病理学弥漫性肺泡损伤 (DAD) 且没有特定基础疾病的特发性成人呼吸窘迫综合征 (ARDS) 患者中,我们将组织病理学发现与他们的影像学图像进行了比较,以研究影像学图像的详细分析和临床过程。这些患者被大致归类为特发性ARDS的间质性肺炎显性类型 (IP型),其中肺泡间隔增厚,肺泡炎或两者都是主要的组织学发现,并且图像显示小蜂窝肺的肺视野衰减增加,或组织肺炎显性类型 (OP型),其中组织渗出液在组织学上主要填充肺泡,图像显示有一些空气的巩固阴影。在临床病程较短的患者中,透明膜非常常见,并且根据较长的临床病程,两种类型的透明膜均被组织透明膜覆盖,广泛的纤维化和蜂窝状肺。根据肺功能和影像学图像判断,正常肺部结构塌陷较少且影像学变化较大的OP型患者似乎对类固醇治疗反应相对有利。
  • 【在ARDS猪模型中应用死空间分数滴定最佳呼气末正压。】 复制标题 收藏 收藏
    DOI:10.3892/etm.2017.4117 复制DOI
    作者列表:Bian W,Chen W,Chao Y,Wang L,Li L,Guan J,Zang X,Zhen J,Sheng B,Zhu X
    BACKGROUND & AIMS: :This study aimed to apply the dead space fraction [ratio of dead space to tidal volume (VD/VT)] to titrate the optimal positive end-expiratory pressure (PEEP) in a swine model of acute respiratory distress syndrome (ARDS). Twelve swine models of ARDS were constructed. A lung recruitment maneuver was then conducted and the PEEP was set at 20 cm H2O. The PEEP was reduced by 2 cm H2O every 10 min until 0 cm H2O was reached, and VD/VT was measured after each decrement step. VD/VT was measured using single-breath analysis of CO2, and calculated from arterial CO2 partial pressure (PaCO2) and mixed expired CO2 (PeCO2) using the following formula: VD/VT = (PaCO2 - PeCO2)/PaCO2. The optimal PEEP was identified by the lowest VD/VT method. Respiration and hemodynamic parameters were recorded during the periods of pre-injury and injury, and at 4 and 2 cm H2O below and above the optimal PEEP (Po). The optimal PEEP in this study was found to be 13.25±1.36 cm H2O. During the Po period, VD/VT decreased to a lower value (0.44±0.08) compared with that during the injury period (0.68±0.10) (P<0.05), while the intrapulmonary shunt fraction reached its lowest value. In addition, a significant change of dynamic tidal respiratory compliance and oxygenation index was induced by PEEP titration. These results indicate that minimal VD/VT can be used for PEEP titration in ARDS.
    背景与目标: : 本研究旨在应用死空间分数 [死空间与潮气量的比率 (VD/VT)] 来滴定猪急性呼吸窘迫综合征模型 (ARDS) 中的最佳呼气末正压 (PEEP)。构建了12个ARDS猪模型。然后进行肺募集操作,并将PEEP设定为20厘米H2O。每10分钟通过2厘米H2O降低PEEP,直到达到0厘米H2O,并且在每个减量步骤之后测量VD/VT。VD/VT使用CO2的单次呼吸分析进行测量,并使用以下公式从动脉CO2分压 (PaCO2) 和混合呼气CO2 (PeCO2) 计算: VD/VT = (PaCO2-PeCO2)/PaCO2。通过最低VD/VT方法确定最佳PEEP。在损伤前和损伤期间以及在最佳PEEP (Po) 之下和之上的4和2厘米H2O处记录呼吸和血液动力学参数。发现本研究中的最佳PEEP为13.25 ± 1.36厘米H2O。与损伤期间 (0.68 ± 0.10) 相比,在Po期间VD/VT降低至较低值 (0.44 ± 0.08) (P<0.05),而肺内分流分数达到最低值。此外,通过PEEP滴定引起动态潮气呼吸顺应性和氧合指数的显着变化。这些结果表明,最小VD/VT可用于ARDS中的PEEP滴定。
  • 【皮质类固醇治疗芽生菌病诱导的ARDS: 两名患者的报告和文献复习。】 复制标题 收藏 收藏
    DOI:10.1378/chest.07-2778 复制DOI
    作者列表:Lahm T,Neese S,Thornburg AT,Ober MD,Sarosi GA,Hage CA
    BACKGROUND & AIMS: :ARDS secondary to blastomycosis is associated with a high mortality rate despite appropriate antifungal therapy. Corticosteroids are of proven benefit in the treatment of severe Pneumocystis jiroveci pneumonia and are recommended for the treatment of severe pulmonary infections with Histoplasma capsulatum. However, their role in the treatment of severe pulmonary infections with Blastomyces dermatitidis has not been established. We report the cases of two previously healthy men who presented with severe ARDS secondary to blastomycosis. Refractory hypoxemia developed in both patients despite adequate antifungal coverage with amphotericin B. Dramatic improvement was seen in each patient after initiation of corticosteroids in addition to amphotericin B. Both patients survived and did well on follow-up. We suggest that treatment with corticosteroids may be of benefit in patients with blastomycosis-induced ARDS. This may be due to a decrease in the severity of the inflammatory response.
    背景与目标: : 尽管进行了适当的抗真菌治疗,但继发于芽生菌病的ARDS仍具有较高的死亡率。皮质类固醇在治疗严重的肺孢子虫性肺炎中被证明是有益的,并被推荐用于治疗严重的肺部感染,并带有组织胞浆菌。然而,尚未确定它们在治疗严重的肺部感染中的作用。我们报告了两名先前健康的男性的病例,这些男性继发于芽生菌病而患有严重的ARDS。尽管两性霉素b有足够的抗真菌覆盖,但两名患者均出现了难治性低氧血症。除两性霉素b外,每位患者在开始使用皮质类固醇后均得到显着改善。两名患者均存活,并在随访中表现良好。我们建议皮质类固醇治疗可能对芽生菌病诱导的ARDS患者有益。这可能是由于炎症反应的严重程度降低所致。
  • 【[成人呼吸窘迫综合征 (ARDS) 的病理生理和治疗方面]。】 复制标题 收藏 收藏
    DOI:10.1055/s-2007-1000529 复制DOI
    作者列表:Thiel M,Forst H,Peter K
    BACKGROUND & AIMS: :Since the first characterization of the adult respiratory distress syndrome (ARDS), knowledge of its aetiology and pathogenesis has grown considerably. In spite of this, mortality remains up to 50 to 90%, particularly if multiple organ failure is present. Because no causative clinical therapy is available up to now, significant attention is given to preventive measures like early operative stabilisation of long bone fractures, or prophylaxis of nosocomial infections. After clinical manifestation of ARDS, treatment focuses on functional disturbances of the cardiopulmonary system and on the underlying disease. The aim of this symptomatic therapy is to ensure oxygen supply according to the organisms demand. It is still unknown, however, whether the mortality of patients with ARDS can be reduced by optimising the oxygen supply. In general, oxygen supply can be enhanced by improving pulmonary gas exchange, cardiac output and blood oxygen transport capacity. For practical use the therapy often ends up with a therapeutical dilemma: On one hand, the improvement of the pulmonary gas exchange by application of PEEP can be associated with a critical decline in cardiac output, particularly if the afterload of the right ventricle is elevated. On the other hand, to increase cardiac output, both volume replacement and vasodilators can severely affect pulmonary gas exchange if the alveolo-capillary permeability is increased and pulmonary hypoxic vasoconstriction is disturbed. Thus, oxygen supply can be optimised only via invasive monitoring of the cardiorespiratory system. Although still experimental, the most promising approaches seem to be pharmacological interventions directed at suppressing the formation and effects of various humoral and cellular mediators. An improved understanding of the inflammatory processes might provide new insights in the pathophysiology of ARDS and the related therapeutic interventions.
    背景与目标: : 自成人呼吸窘迫综合征 (ARDS) 首次表征以来,对其病因和发病机理的了解已大大增加。尽管如此,死亡率仍然高达50至90%,特别是如果存在多器官功能衰竭。由于到目前为止尚无致病的临床治疗方法,因此应特别注意预防措施,例如早期手术稳定长骨骨折或预防医院感染。在ARDS的临床表现之后,治疗的重点是心肺系统的功能障碍和潜在的疾病。这种对症疗法的目的是根据生物体的需求确保氧气供应。然而,是否可以通过优化氧气供应来降低ARDS患者的死亡率仍然未知。通常,可以通过改善肺气体交换,心输出量和血氧输送能力来增强氧气供应。对于实际使用,该疗法通常会导致治疗上的困境: 一方面,通过使用PEEP来改善肺气体交换可能与心输出量的严重下降有关,特别是如果右心室的后负荷升高。另一方面,如果肺泡毛细血管通透性增加并且肺缺氧血管收缩受到干扰,则为了增加心输出量,容量置换和血管扩张剂都会严重影响肺气体交换。因此,只能通过对心肺系统的侵入性监测来优化氧气供应。尽管仍是实验性的,但最有前途的方法似乎是旨在抑制各种体液和细胞介质的形成和作用的药理干预。对炎症过程的更好理解可能会为ARDS的病理生理学和相关的治疗干预提供新的见解。

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