肺部超声与ARDS预后

1、重症超声整合的ARDS诊疗可否改善患者预后？山东大学齐鲁医院重症医学科 杜鹃CT与ARDSWhat Has Computed Tomography Taught Us about the Acute Respiratory Distress Syndrome?LUCIANO GATTINONI, PIETRO CAIRONI, PAOLO PELOSI, and LAWRENCE R. GOODMANAm J Respir Crit Care Med Vol 164. pp 17011711, 2001肺超声可以改善ARDS患者预后吗山东大学齐鲁医院 杜鹃 创伤后早期LUS预测ARDS发生Ea

2、rly lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patientsD. Leblanc C. Bouvet F. Degiovanni G. Bouhours E. Rineau L. Beydon S. LasockiIntensive Care Med 2014 Jul 15LUS可鉴别ARDS与APEChest sonography: a useful tool to differentiate acute cardiogenic

3、pulmonary edema from acute respiratory distress syndromeRoberto Copetti*1, Gino Soldati2 and Paolo Copetti1 Cardiovascular Ultrasound 2008, 6:16ARDS鉴别诊断以下超声征象提示ARDS的诊断：1.前胸的胸膜下实变2.肺滑动减弱或消失3.与异常肺实质毗邻存在正常的肺实质4.胸膜线的异常（不规则增粗片段状的胸膜线）5.分布不匀齐的B线International evidence-based recommendations for point-of-care

4、 lung ultrasound.Intensive Care Med 2012 Apr;38(4):577-91.LUS评价肺水Lung water assessment by lung ultrasonography in intensive care: a pilot studyGiacomo Baldi,etc. Intensive Care Med (2013) 39:7484LUS评估肺复张Using sonography to assess lung recruitment in patients with acute respiratory distress syndrome

5、Greta Gardelli Francesco Feletti，etc Emerg Radiol (2009) 16:219221实 时Lung sonography and recruitment in patients with early acute respiratory distress syndrome:a pilot studyStefanidis et al. Critical Care 2011, 15:R185LUS评估肺复张实变的肺下叶正常通气肺组织实变的肺下叶聚集的B线聚集的B线散在的B线B3 线B7线半定量评价方法：肺复张评分LUS评价肺复张Bedside Ultr

6、asound Assessment of Positive End-Expiratory Pressureinduced Lung RecruitmentAm. J. Respir. Crit. Care Med. February 1, 2011 vol. 183Compare the pressurevolume (PV) curve method with LUS for assessingPEEP-induced lung recruitment in patients with ARDS/ALICAUTION : 超声无法检测过度通气ARDS肺可复张性与过度通气Lung Recrui

7、tment in Patients with the Acute Respiratory Distress Syndromen engl j med 354;17 april 27, 2006LUS与右心在保护性通气策略的ARDS患者ACP发生率22%25%ARDS与ACPARDS与ACP肺血管收缩、阻塞及血管内皮功能障碍 不恰当的机械通气肺血管阻力升高RV扩张、动度减低及室间隔移位加重休克卵圆孔开放，氧合恶化死亡率增加炎症因子right ventricle protective ventilation approachs加重休克卵圆孔开放，氧合恶化气胸的LUS征象气胸的诊断：肺滑动征消失平流

8、层征气胸的除外诊断：B线肺脉肺滑动征气胸的确诊：肺点LUS对气胸的诊断价值Test Characteristics of Ultrasonography for the Detection of PneumothoraxA Systematic Review and Meta-analysisKhaled Alrajhi , MD; Michael Y. Woo , MD; and Christian Vaillancourt , MDCHEST 2012; 141(3):703708ECHO与脱机ECHO预测脱机Echocardiography. A help in the weaning

9、process. Caille V, Amiel JB, Charron C, et al. Crit Care 2010; 3:R120.超声诊断SBT诱导的PAOP的升高Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilationCrit Care Med 2009 Vol. 37, No. 5超声评价膈肌运动Diaphragm dysfunction assessed by ultrasonography: Influence on weaning from mechanical ventilationCrit Care Med 2011 Vol. 39, No. 12超声评价膈肌运动Diaphragm ultrasound as a new index of discontinuation from mechanical ventilationFerrari et al. Critical Ultrasound Journal 2014, 6:8Key Point早期肺超声可预测ARDS的发生鉴别诊断评价肺水含量肺超声可实时评估肺复张肺超声可以早期发现复张并