急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)  

Guidelines for management of acute lung injury/acute respiratory distress syndrome: an evidence-based update by the Chinese Society of Critical Care Medicine (2006) Chinese Society of Critical Care Medicine , Chinese Medical Association

作　　者：马晓春[1] 王辰[1] 方强[1] 刘大为[1] 邱海波[1] 秦英智[1] 席修明[1] 黎毅敏[1] 

机构地区：[1]中华医学会重症医学分会

出　　处：《中国危重病急救医学》2006年第12期706-710,共5页Chinese Critical Care Medicine

摘　　要：Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve . Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended . The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evidence-based Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury （ALI） /acute respiratory distress syndrome （ARDS）, that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure （PEEP） should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve. Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended. The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evide

关 键 词：急性肺损伤 病死率 氧合 死亡率 ARDS ALI 急性呼吸窘迫综合征 小潮气量通气 俯卧位通气 机械通气患者 治疗指南 

分 类 号：R563.8[医药卫生—呼吸系统]