急性呼吸圧迫症候群に対する最新の呼吸管理

概要

論文の詳細を見る
The mortality rate of acute respiratory distress syndrome (ARDS) has been still high.　A many kinds of strategies for ARDS are being tried in the world. The important factors which influence for pathological-physiology of ARDS during the mechanical ventilation are gravity consolidation, atelectasis, and ventilator induced lung injury (VILI). VILI is caused by shear stress that is induced by the repeated collapse and recruit of alveolus. Alveolar over-distention caused by large tidal volume also induces VILI. To prevent the VILI, the open lung strategy (The lung protective strategies for ARDS) is recommended. The high positive end expiratory pressure (PEEP) that prevents the shear stress and a small tidal volume are necessary for ARDS treatment.　The concept of the open lung strategy is re-open of alveolus and keeping the recruited alveolus. Recruitment maneuver, preventive therapy by PEEP, and prone positioning are lately proposed in the world. Recruitment maneuver is likely to inspire the gas at the level of vital capacity. Preventive PEEP is useful for the secondary lung injury of sepsis, burn and trauma. Prone position in Intensive Care Unit that is recognized to increase the oxygenation for lung injury patients may improve the mortality of severe ARDS patients.　Key words ： Acute Respiratory Distress Syndrome, acute lung injury, recruitment maneuver, pressure volume curve, prone position
山形大学の論文
2003-02-17