复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）呼吸系统_Acute Respiratory Disease Syndrome

Acute Respiratory Disease Syndrome Yuanlin Song, MD

Yuanlin Song, M.D

Definition o Clinical syndrome of severe dyspnea of rapid onset, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure SIS Aspiration rauma Pneumonia rauma SARS

 Clinical syndrome of severe dyspnea of rapid onset, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure. Pneumonia Trauma SARS

Diagnostic criteria o PaO2/fiO2 <300 (ARDS if 200 o Bilateral alveolar or interstitial infiltrates o PCWP<18 mmHg, or no clinical evidence of Increase left atrium pressure

 PaO2/fiO2<300 (ARDS if < 200)  Bilateral alveolar or interstitial infiltrates  PCWP < 18 mmHg, or no clinical evidence of increase left atrium pressure

Classfication Direct lung injury Indirect lung injury neumonla epsis Aspiration Severe trauma Pulmonary contusion Multiple bone fracture Near-drowning Flail chest Toxic inhalation injury Head trauma Multiple transfusion Bu urns Drug overdose Pancreatitis Post-cardiopulmonary bypass

Direct lung injury Indirect lung injury Pneumonia Sepsis Aspiration Severe trauma Pulmonary contusion Multiple bone fracture Near-drowning Flail chest Toxic inhalation injury Head trauma Multiple transfusion Burns Drug overdose Pancreatitis Post-cardiopulmonary bypass

epidemiology o Annual incidence: 30/100, 000 for ALI and 10/100, 000 for ARDS o 10%ICU admission may have acute respiratory allure o Morality: 40-70% worldwide o In China, around 700,000 new cases per year o In Shanghai, mortality was 70% in 2001 o Death number comparable to hiv, cl, breast cancer

 Annual incidence: 30/100,000 for ALI and 10/100,000 for ARDS  10% ICU admission may have acute respiratory failure  Morality: 40-70% worldwide  In China, around 700,000 new cases per year  In Shanghai, mortality was 70% in 2001  Death number comparable to HIV, CI, breast cancer

Etiology of ALI/ARDS Sepsis Pneumonia Trauma Multiple transfusion Aspiration Drug over dose Risk factors Old age Chronic alcohol abuse Metabolic acidosis Severity of critical illness Protective factors Diabetes

Sepsis Pneumonia Trauma Multiple transfusion Aspiration Drug over dose Risk factors Old age Chronic alcohol abuse Metabolic acidosis Severity of critical illness Protective factors Diabetes

Pathology of ALI/ARDS ◇ Exudative phase ◇ Proliferative phase ◇ Fibrotic phase

 Exudative phase  Proliferative phase  Fibrotic phase

Pathophysiology Repopulation of Proliferation and Aleolar Gradual differentiation resolution of type ll cell ype l and Ill Resorption of alveolar edema fluid and protein

Treatment Principle 1. Underlying disease control 2. Reduce Ventilator induced lung injury 3. Prevention of venous thromboembolism GI bleeding, catheter infection 4. Prevent and recognition of HAP 5. Support therapy: nutrition, ventilation, fluid antibiotics

Treatment Principle: 1. Underlying disease control 2. Reduce Ventilator induced lung injury 3. Prevention of venous thromboembolism, GI bleeding, catheter infection 4. Prevent and recognition of HAP 5. Support therapy: nutrition, ventilation, fluid, antibiotics

Mechanical ventilation strategy principles 1. Selection of non-invasive and invasive ventiation 2. Management of artificial airways 3. Ventilation mode: IPPV PSV SIMV PRV NAVA 4. PEEP 5. Ventilation parameters: Volume, RR 6. Other methods: HFV. ECMO, PLV

Mechanical ventilation strategy principles 1. Selection of non-invasive and invasive ventialtion 2. Management of artificial airways 3. Ventilation mode: IPPV, PSV, SIMV, PRV, NAVA, 4. PEEP: 5. Ventilation parameters: Volume, RR, 6. Other methods: HFV, ECMO, PLV