tailieunhanh - Báo cáo y học: "Is acute respiratory distress syndrome an iatrogenic disease"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Is acute respiratory distress syndrome an iatrogenic disease? | Villar and Slutsky Critical Care 2010 14 120 http content 14 1 120 CRITICAL CARE COMMENTARY L__ Is acute respiratory distress syndrome an iatrogenic disease Jesus Villar1 2 3 and Arthur S Slutsky 3 4 5 See related research by Determann etal. http content 14 1 R1 Abstract In this month s issue of CriticalCarp Determann and colleagues report the results of a randomized controlled trial comparing the effects of mechanical ventilation MV with two tidal volumes 6 versus 10 ml kg predicted body weight on cytokine levels in lung lavage fluid and plasma as a surrogate for early identification of acute lung injury ALI and or acute respiratory distress syndrome ARDS . The study was stopped early after an interim analysis -when 150 patients were enrolled - showing that the incidence of ALI ARDS according to the current definition was higher in the 10 ml kg group although duration of MV and mortality was similar in both groups. We examine these interesting results after providing a brief historical perspective and discuss the limitations and implications of the study. Mechanical ventilation MV is the second most frequent therapeutic intervention performed in ICUs after treatment of cardiac arrhythmias and is the most important intervention in patients with respiratory failure. However it is associated with several complications including increased risk of pneumonia impaired cardiac function and development of lung injury. There is now unequivocal evidence from both experimental and clinical studies that MV can cause or aggravate acute lung injury ALI - a concept termed ventilator-induced lung injury VILI . Many of the pathophysiological consequences of VILI mimic those of acute respiratory distress syndrome ARDS 1 . Is this relationship a coincidence or could there be a more sinister explanation - we address this issue later in this commentary. Correspondence slutskya@ 3St Michael s Hospital 30 Bond Street Toronto Ontario