tailieunhanh - Báo cáo y học: "New and conventional strategies for lung recruitment in acute respiratory distress syndrome"

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: New and conventional strategies for lung recruitment in acute respiratory distress syndrome. | Pelosi et al. Critical Care 2010 14 210 http content 14 2 210 CRITICAL CARE REVIEW L_ New and conventional strategies for lung recruitment in acute respiratory distress syndrome Paolo Pelosi 1 Marcelo Gama de Abreu2 and Patricia RM Rocco3 This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 Springer Verlag and co-published as a series in Critical Care. Other articles in the series can be found online at http ccforum series yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http series 2855. Introduction Mechanical ventilation is a supportive and life saving therapy in patients with acute lung injury ALI acute respiratory distress syndrome ARDS . Despite advances in critical care mortality remains high 1 . During the last decade the fact that mechanical ventilation can produce morphologic and physiologic alterations in the lungs has been recognized 2 . In this context the use of low tidal volumes VT and limited inspiratory plateau pressure Pplat has been proposed when mechanically ventilating the lungs of patients with ALI ARDS to prevent lung as well as distal organ injury 3 . However the reduction in VT may result in alveolar derecruitment cyclic opening and closing of atelectatic alveoli and distal small airways leading to ventilator-induced lung injury VILI if inadequate low positive end-expiratory pressure PEEP is applied 4 . On the other hand high PEEP levels may be associated with excessive lung parenchyma stress and strain 5 and negative hemodynamic effects resulting in systemic organ injury 6 . Therefore lung recruitment maneuvers have been proposed and used to open up collapsed lung while PEEP counteracts alveolar derecruitment due to low VT ventilation 4 . Lung recruitment and stabilization through use of PEEP are illustrated in Figure 1. Nevertheless the beneficial effects of recruitment maneuvers in ALI ARDS