呼吸衰竭和急性呼吸窘迫综合征-英文课件.ppt

1、UTHSCSA Pediatric Resident Curriculum for the PICU,RESPIRATORY FAILURE 335-347, 1988,PATHOLOGY OF ARDS,Green arrows point to hyaline membrane Blue arrows point to type II pneumocytes and alveolar macrophages,MANAGEMENT,Meticulous supportive care is the mainstay of therapy Prevent secondary lung inju

2、ry Ensure adequate cardiac output Limit secondary infections Drugs Good nutrition,VENTILATOR STRATEGIESThe hallmark of ARDS is heterogeneous lung.,Limit Barotrauma Keep PIP 7.20,Limit O2 Toxicity Give enough PEEP to lower FiO2 to 90%. PEEP E) ventilation.,CARDIAC OUTPUT,Keep cardiac output 4.5 L/min

3、/m2. Keep O2 delivery 600 ml O2/min/m2. Keep Hct 30%, higher if signs of heart failure. Use inotropes to augment cardiac output. Ensure adequate preload.,LIMIT SECONDARY INFECTIONS,Wash your hands. Use the gut as soon as possible for nutrition and meds. Discontinue indwelling catheters as soon as po

4、ssible. Have high index of suspicion. Treat infections early, but tailor antibiotics to culture results.,DRUGS,Diuretics: a dry lung is a good lung. Inotropes Steroids: 2mg/kg/day begun after a week into the course may be of benefit, otherwise dont use. Pulmonary vasodilators (nitric oxide, prostagl

5、andins, nitroprusside): of little benefit. NO may be of benefit in some patients. Surfactant replacement: probably no benefit NSAIDs: no clinical benefit,NUTRITION,Ensure adequate calories as soon as possible: 50-60kcal/kg/day in infants 35-45kcal/kg/day in older children. After day 4, increase calories by 25-50% above baseline. Begin enteral feeds as soon as is safe. “Pulmonary” formulas probably of little benefit.,MORTALITY/MORBIDITY,Published mortality is 50% in children. Pulmonary failure accounts for only 15% of the de