tailieunhanh - Báo cáo khoa học: "Ventilatory management of ARDS: high frequency oscillation and lung recruitment"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Ventilatory management of ARDS: high frequency oscillation and lung recruitment!. | Available online http content 10 4 158 Commentary Ventilatory management of ARDS high frequency oscillation and lung recruitment Robert M Kacmarek Harvard Medical School and Respiratory Care Massachusetts General Hospital Ellison 401 55 Fruit Street Boston MA. USA Corresponding author Robert M Kacmarek rkacmarek@ Published 24 August 2006 This article is online at http content 10 4 158 2006 BioMed Central Ltd Critical Care 2006 10 158 doi cc5018 See related research by David et al. http content 10 4 R100 Abstract Many aspects of ventilatory management in patients with ARDS are still controversial and one of the major controversies is should HFO or CMV ideally be used to manage this patients. As shown by David et al. when the two approaches to ventilatory support are applied using similar principles the physiologic outcomes appear to be similar. With both approaches the use of lung recruitment maneuvers early in ARDS 1 to 3 day after hemodynamic stabilization in patients without baratrauma is promising. The key to managing ARDS regardless of mode is to use an open lung protective ventilatory strategy. It is not the mode that makes the difference it is the approach used to apply the mode It is now clearly established that the approach to ventilatory support in acute respiratory distress syndrome ARDS can have a negative impact on outcome 1 . Most would agree that overdistension and opening and closing of unstable lung units should be avoided 2 . However the precise methodology to accomplish these two primary goals of ventilatory support is still hotly debated. Should we use conventional mechanical ventilation or high frequency oscillation HFO Should we use low positive end-expiratory pressure PEEP or high PEEP Should we recruit the lung or allow it to gradually open over time In spite of the scores of laboratory and clinical studies addressing these questions published over the years these questions are still .