tailieunhanh - Báo cáo hóa học: " Ventilator-induced lung injury: historical perspectives and clinical implications"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài: Ventilator-induced lung injury: historical perspectives and clinical implications | de Prost et al. Annals of Intensive Care 2011 1 28 http content 1 1 28 Ù Annals of Intensive Care a SpringerOpen Journal REVIEW Open Access Ventilator-induced lung injury historical perspectives and clinical implications Nicolas de Prost1 Jean-Damien Ricard2 3 4 Georges Saumon2 and Didier Dreyfuss2 3 4 Abstract Mechanical ventilation can produce lung physiological and morphological alterations termed ventilator-induced lung injury VILI . Early experimental studies demonstrated that the main determinant of VILI is lung end-inspiratory volume. The clinical relevance of these experimental findings received resounding confirmation with the results of the acute respiratory distress syndrome ARDS Network study which showed a 22 reduction in mortality in patients with the acute respiratory distress syndrome through a simple reduction in tidal volume. In contrast the clinical relevance of low lung volume injury remains debated and the application of high positive end-expiratory pressure levels can contribute to lung overdistension and thus be deleterious. The significance of inflammatory alterations observed during VILI is debated and has not translated into clinical application. This review examines seminal experimental studies that led to our current understanding of VILI and contributed to the current recommendations in the respiratory support of ARDS patients. Introduction The prognosis of the acute respiratory distress syndrome ARDS has improved dramatically within the past decades with in-hospital mortality rates ranging from 90 in the seventies 1 to approximately 30 in a recent study 2 . Reduction of the tidal volume delivered to mechanically ventilated patients and thus of the stress applied to their lungs unambiguously contributed to improving outcomes as demonstrated by the ARDSnet study which showed a 22 higher survival in patients who received lower 6 mL kg than in those who received larger 12 mL kg tidal volumes 3 . Interestingly