The management of acute respiratory distress syndrome

The Management of Acute Respiratory Distress Syndrome 署立桃園醫院胸腔內科林倬睿醫師

Outlines ,[object Object],[object Object],[object Object],[object Object]

定義 Definition ,[object Object],[object Object],[object Object],[object Object]

致病原因 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Differential Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lancet 2007; 369:1553-65

Prognosis & Outcome ,[object Object],[object Object],[object Object],[object Object],Lancet 2007; 369:1553-65

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lancet 2007; 369:1553-65

Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]

Supportive Care ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ventilator-induced Lung Injury (VILI) ,[object Object],[object Object],[object Object],[object Object],Over Distension Collapse

Volutrauma ,[object Object],[object Object],[object Object],[object Object],AJRCCM 1998; 157: 294-323

Atelectrauma ,[object Object],[object Object],[object Object],PEEP PEEP PEEP Lung edema

The PEEP Effect NEJM 2006;354:1839-1841

Ventilator-induced Lung Injury (VILI) Upper Deflection point Lower Inflection point

[object Object],Lung-Protective Ventilation NEJM 2000; 342: 1301-1308 39.8% 31.0% Result (p<0.001) 9.1 8.1 Actual PEEP Protocol Protocol PEEP <50 <30 P plateau 12 6 Tidal Volume (ml/kg) Conventional ventilation Lung-protective ventilation 18-24 14-18 14 10-14 10 8-10 5-8 5 PEEP 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 FiO2 Principle for FiO2 and PEEP Adjustment

[object Object],[object Object],[object Object],Lung-Protective Ventilation NEJM 2000; 342: 1301-1308

Concerns when using lung-protective strategy… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Other Ventilator Strategies ,[object Object],[object Object],[object Object]

Lung Recruitment ,[object Object],[object Object],[object Object],NEJM 2007; 354: 1775-1786

Lung Recruitment NEJM 2007; 354: 1775-1786

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lung Recruitment Sensitivity : 71% Specificity : 59% NEJM 2007; 354: 1775-1786

[object Object],[object Object],[object Object],[object Object],Lung Recruitment

Prone Position ,[object Object],[object Object],[object Object],[object Object]

Prone Position NEJM 2001;345:568-573

[object Object],[object Object],[object Object],[object Object],[object Object],Prone Position

High-Frequency Oscillatory Ventilation (HFOV)

HFOV Frequency: 180-600 breaths/min (3-10Hz)

Effect of HFOV on gas exchange in ARDS patients AJRCCM 2002; 166:801-8

Survival difference of ARDS patients treated with HFOV or CMV 30-day: P=0.057 90-day: P=0.078 AJRCCM 2002; 166:801-8

HFOV ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Chest 2007; 131:1907-1916

Adjunctive Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Steroid therapy NEJM 2006;354:1671-1684

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Steroid therapy NEJM 2006;354:1671-1684

Fluid Management NEJM 2006;354:2564-2575

Fluid Management NEJM 2006;354:2213-24

[object Object],[object Object],[object Object],Fluid Management

Extracorporeal Membrane Oxygenation (ECMO) ,[object Object],[object Object],[object Object]

Nitric Oxide ,[object Object],[object Object],[object Object],[object Object]

Unproven Treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lancet 2007; 369:1553-65

Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The management of acute respiratory distress syndrome

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The management of acute respiratory distress syndrome

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