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ALI & ARDS

!!!

:
, -,
-, -
3 : ()

-

II

III

, ,

Copyright Lippincott Williams&Wilkins, 2005

IV

VI


2
2

Copyright Lippincott Williams&Wilkins, 2005


(
FRC)

Live Presentation, Arthur S. Slutsky MD, St Michelles Hospital, Toronto Canada


13th Annual Congress of the European Society for Intensive Care Medicine
October 2, 2000, Rome Italy


(pO2/FiO2) , 50
mmHg

R

-
,



- - upper inflection point
(UIP) - 30-40 c H2O 20-40
?

(Sighs)?

PEEP?
, PEEP
,


( !)

10 1000-1200 ,
PEEP 10-12 cm H2O

pO2/FiO2

: Pressure Control ( = 8 cm H2O, max 32


cm H2O , Cdyn < 60 cm H2O /L, VT = 10 /, f = 20, I:E =
1:1, FiO2=0,21)
: 20 cm H2O max
50 cm H2O (+ 30 cm H2O ) - 2
: max 38 cm H2O
(+ 18 cm H2O ). Cdyn
PEEP
max 2 cm H2O.
Cdyn ( V t )
: 20 cm H2O
max 50 cm H2O (+ 30 cm H2O ) - 2
: + 2 cm
H2O . + 12-14 cm H2O
: V t 7-9 /

Total Recuitment [%]

10

20

30

Pressure [cmH2O]

40

50

60

pen lung rest


(< 30 c H20 6 /)
Amato, AJRCCM 1995;152:1835-1846
Amato, NEJM 1998; 338:347-354
ARDS Network N Engl J Med 2000;342:1301-08


(Inflection Points)

0.6

0.4

0.2

B
-40

-20

20

40


( )

-, -,
-

Pmax = 30-35 cm H2O


VT = 8-10 / ( )
VT = 6-7 / (ALI, ARDS)
= 5-6 cm H2O
VT (1 50100 ) 510 cm H2O

? (2 > 55
Hg)

( 2 = 60 Hg, Sat O2 = 89%)

,


. ! :
1.

Hipcrates
(6 / 8 /, Vt Noli Nocere
P )?
plat

2.



(, )?

3.

,
?

4.

5.

6.

1.


?11

1.
VT 6 /?

-
ARDS study
VT=12 /

Eichacker et al. Am J Respir Crit Care Med 2002;
166:1510-1514




Stewart et al. N Engl J Med 1998; 338: 355-361
Brochard et al. Am J Respir Crit Care Med 1998; 158:
1831-1838

2.
!

3.
, ?



-
.


Marini with permission

4.
?
:

,
, ,



,

30 cm H20

Lung
A
Lung

Lung
B
Lung

-20

B
Lung
B

,

-20

-20

,
Vt?

6 ml/kg?

,
Vt?



?

5. Pressure vs. Volume


Ventilation

,
,

6.
?

, =

(FRC) - APRV ? HFO? ARDS Network?


MAP,
, HFO & APRV
,

APRV & ARDS Network


30

cmH20

Pressure

20
10
0

APRV

HFO

ARDS Network

7. ?


open lung rest
-, -, -

Pmax = 30-35 cm H2O


VT = 8-10 / ( )
VT = 6-7 / ( )
= 5-6 cm H2O
VT (1 50-100 )
510 cm H2O
(2 = 36-40 Hg)
(
2 = 100 Hg, Sat O2 = 99%)

Lung rest + zero

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