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Conclusions The current pathophysiologic scenario of ARDS includes ventilator-induced lung injury as a factor that can worsen the severity of the syndrome. The literature reviewed above documents that spontaneous or mechanical ventilation of normal lungs alters surfactant and increases surface tension, that increased surface tension is necessary and sufficient to cause atelectasis, that atelectasis is augmented by supine positioning and sedation, that constant VT ventilation limits surfactant release from type II pneumocytes and that changes in surfactant occur prior to the onset of ARDS. These findings suggest a new pathophysiologic scenario for ARDS, one in which normal lung regions become atelectatic from the increase in surface tension resulting from spontaneous or mechanical ventilation-induced decreases in surfactant, together with our current approaches to patient positioning and sedation. Spontaneous or mechanical ventilation of these atelectatic regions then causes the initial lung injury via atelectrauma. If the proposed scenario were correct at least some instances of ARDS might be prevented by routinely administering sigh breaths in addition to ventilating with low VTs and at least low levels of PEEP, by avoiding supine positioning, by increasinthe frequency of repositioning and the use of prone or semi-prone positioning, by limiting the use of sedation, and by implementing these changes in practice from the time patients are admitted and/or mechanical ventilation is initiated rather than waiti until ARDS has developed. Although these ideas are supported by considerable literature, they remain hypotheses that require testing in patients at risk for ARDS. |
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8楼2012-08-20 22:16:04
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至尊木虫 (职业作家)
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2楼2012-08-20 16:03:31
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【答案】应助回帖
sltmac: 金币-5, 本版禁止机器翻译，请应助前仔细阅读版规 2012-08-20 21:46:43
sltmac: 违规存档 2012-08-20 21:47:02
小核桃小: 金币+5, 翻译EPI+1, ★有帮助, 还是不够好，谢谢 2012-08-20 22:15:43
sltmac: 违规存档 2012-08-20 21:47:02
小核桃小: 金币+5, 翻译EPI+1, ★有帮助, 还是不够好，谢谢 2012-08-20 22:15:43
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用有道翻译，虽然不太标准，但是你稍微改一下就好了 结论 当前的病理生理的场景包括通风机诱导肺的ARDS 受伤是一个因素,可以进一步恶化的严重性综合症。一文献回顾上述文件,自发或机械通风的正常肺改变表面活性剂和增加表面张力,提高表面张力是必要的,足以引起肺不张、肺不张,增强了懒散的定位和镇静,常数VT通风限制表面活性剂从II型pneumocytes释放,改变发生在表面活性剂爆发之前,ARDS。这些发现提出了一个新的ARDS病理生理的场景,一个正常的肺萎陷地区成为从增加的表面张力源于自发或机械通气诱导减少表面活性剂,连同我们当前的方法来定位和镇静病人。自发或机械通风的这些萎陷地区然后导致最初通过atelectrauma肺损伤。如果提出的场景是正确的,至少一些实例可以预防的ARDS通过定期 管理叹息呼吸除了通风与低变形机和至少低水平的窥视,通过避免仰卧的定位,通过increasinthe频率的重新定位和使用容易或半容易定位,通过限制使用镇静,通过实现这些变化实际上从病人承认和/或机械通风启动而不是waiti直到ARDS已经开发了。虽然这些想法都支持相当大的文学,他们仍然需要测试假设在危险的患者ARDS。 |
3楼2012-08-20 17:11:58
4楼2012-08-20 17:40:27
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