Postpartum extracorporeal membrane oxygenation of a woman with COVID-19-related acute respiratory distress syndrome: A case report

Introduction:Patients with coronavirus disease (COVID-19) may develop acute respiratory distress syndrome (ARDS). There have been few reports of postpartum woman with ARDS secondary to COVID-19 who required respiratory support using veno-venous extracorporeal membrane oxygenation (ECMO). We present the case of a 31-year-old woman who was admitted to hospital at 35 weeks gestation with ARDS secondary to COVID-19 and required ECMO during the postpartum period.Patient concerns:The patient had obvious dyspnea, accompanied by chills and fever. Her dyspnea worsened and her arterial oxygen saturation decreased rapidly.Diagnosis:ARDS secondary to COVID-19.Interventions:Emergency bedside cesarean section. Medications included immunotherapy (thymosin α 1), antivirals (lopinavir/ritonavir and ribavirin), antibiotics (imipenem-cilastatin sodium and vancomycin), and methylprednisolone. Ventilatory support was provided using invasive mechanical ventilation. This was replaced by venous-venous ECMO 5 days postpartum. ECMO management focused on blood volume control, coagulation function adjustment, and airway management.Outcomes:The patient was successfully weaned for ECMO and the ventilator and made a good recovery.Conclusion:Special care, including blood volume control, coagulation function adjustment, and airway management, should be provided to postpartum patients with ARDS secondary to COVID-19 who require ECMO support.     

First successful treatment of a COVID-19 pregnant woman with severe ARDS by combining early mechanical ventilation and ECMO

The novel coronavirus (COVID-19) has become a global pandemic outbreak. Patients with COVID-19 are prone to progress to acute respiratory distress syndrome (ARDS), and even severe ARDS with ineffective mechanical ventilation, and an extremely high mortality. Extracorporeal membrane oxygenation (ECMO) provides effective respiratory support and saves time for the treatment of severe COVID-19. The present study reports that a 31-year-old pregnant female infected by COVID-19, who suffered from fever, dyspnea, and rapid ARDS. The patient's pulmonary function gradually recovered by combining early mechanical ventilation and ECMO, and finally, this patient was successfully weaned from ECMO and the ventilator. No fibrosis lesions were found in the chest CT, and the patient recovered very well after leaving from the hospital for one month.     

Lung recruitment maneuvers in acute respiratory distress syndrome

In the experimental setting, repeated derecruitments of the lungs of ARDS models accentuate lung injury during mechanical ventilation, whereas open lung concept strategies can attenuate the injury. In the clinical setting, recruitment manuevers that use a continuous positive airway pressure of 40 cmH2O for 40 secs improve oxygenation in patients with early ARDS who do not have an impairment in the chest wall. High intermittent positive end-expiratory pressure (PEEP), intermitent sighs, or high-pressure controlled ventilation improves short-term oxygenation in ARDS patients. Both conventional and electrical impedance thoracictomography studies at the clinical setting indicate that high PEEP associated with low levels of pressure control ventilation recruit the collapsed portions of the ARDS lungs and that adequate PEEP levels are necessary to keep the ARDS lungs opened allowing a more homogenous ventilation. High PEEP/low tidal volume ventilation was seen to reduce inflammatory mediators in both bronchoalveolar lavage and plasma, compared to low PEEP/high tidal volume ventilation, after 36 hours of mechanical ventilation in ARDS patients. Recruitment maneuvers that used continuous positive airway pressure levels of 35-40 cmH2O for 40 secs, with PEEP set at 2 cmH2O above the lower inflection point of the pressure-volume curve, and tidal volume < 6 mL/kg were associated with a 28-day intensive care unit survival rate of 62%. This contrasted with a survival rate of only 29% with conventional ventilation (defined as the lowest PEEP for acceptable oxygenation without hemodynamic impairment with a tidal volume of 12 mL/kg), without recruitment manuevers (number needed to treat = 3; p < 0.001). In the near future, thoracic computed tomography associated with high-performance monitoring of regional ventilation may be used at the bedside to determine the optimal mechanical ventilation of the ARDS keeping an opened lung with a homogenous ventilation.     

急性呼吸窘迫综合征家兔肺不同区域有效血流灌注变化及肺保护性通气对其的影响

目的 通过观察家兔急性呼吸窘迫综合征(ARDS)模型肺不同区域有效血流灌注变化及肺保护性通气对其的影响,探讨ARDS所致严重低氧血症的发生机制。方法 采用静脉注射油酸的方法建立家兔ARDS模型,应用PIM-Ⅱ激光多普勒血流灌注扫描仪观察不同肺通气模式[(大潮气、小潮气 外源性呼气末正压(PEEP)、大潮气 俯卧位、俯卧位 小潮气 PEEP]下肺不同区域(肺上区、肺下区腹侧和肺下区背侧)局部有效血流灌注及动脉血气指标的变化。结果 家兔静脉注射油酸后,(1)肺不同区域氧合指数明显下降,应用肺保护性通气(小潮气 PEEP,俯卧位 小潮气 PEEP)后氧合指数明显改善;(2)肺不同区域局部有效血流灌注均有不同程度的下降,以肺下区背侧最为明显,肺下区腹侧次之,肺上区变化最小,应用肺保护性通气后,小潮气 PEEP对改善肺下区背侧胸膜下肺局部有效血流灌注的效果不如俯卧位 小潮气 PEEP。结论小潮气 PEEP、俯卧位 小潮气 PEEP均可良好改善肺局部有效血流灌注,其中俯卧位 小潮气 PEEP效果尤为明显;右-左分流导致的肺内分流可能是ARDS发生严重进行性低氧血症的主要原因之一。     

The effect of driving pressures in COVID-19 ARDS: Lower may still be better as in classic ARDS

BackgroundThe respiratory dynamics of coronavirus disease 2019 (COVID-19) patients under invasive ventilation are still not well known. In this prospective cohort, we aimed to assess the characteristics of the respiratory system in COVID-19 patients under invasive mechanical ventilation and evaluate their relationship with mortality.MethodsFifty-eight COVID-19 patients who underwent invasive mechanical ventilation between March 11, 2020 and September 1, 2020 were enrolled for the present study. Demographics and laboratory values at baseline were recorded. Respiratory variables such as tidal volume, plateau pressure, positive end expiratory pressure, static compliance, and driving pressure were recorded daily under passive conditions. Further, the median values were analyzed.ResultsMedian age of the patients was 64 years (58–72). Mortality was 60% on day 28. Plateau pressure, driving pressure, and static compliance significantly differ between the survivors and non-survivors. When patients were categorized into two groups based on the median driving pressure (Pdrive) of ≤15 cmH₂O or >15 cmH₂O during their invasive mechanical ventilation period, there was significantly better survival on day 28 in patients having a Pdrive ≤ 15 cmH₂O [28 days (95% CI = 19–28) vs 16 days (95% CI = 6–25), (log-rank p = 0.026).ConclusionCOVID-19 related acute respiratory distress syndrome (ARDS) seemed to have similar characteristics as other forms of ARDS. Lung protective ventilation with low plateau and driving pressures might be related to lower mortality.     

Two Cases of Severe COVID-19 Pneumonia Effectively Treated with Extracorporeal Membrane Oxygenation in Addition to Favipiravir and Corticosteroid

Case 1: A 65-year-old man with novel coronavirus infection (COVID-19) complicated with acute respiratory failure. On admission, the patient was started on favipiravir and corticosteroid. However, due to a lack of significant improvement, he was introduced to mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Although iliopsoas hematoma occurred as a complication, the patient recovered. Case 2: A 49-year-old man with COVID-19 had been started on favipiravir and corticosteroid. Due to progressive respiratory failure, the patient underwent mechanical ventilation and ECMO. The patient recovered without complications. We successfully treated these severe cases with a multimodal combination of pharmacological and non-pharmacological supportive therapy.     

The clinical course of critically ill COVID-19 patients receiving invasive mechanical ventilation with subsequent terminal weaning: Primary data from 11 cases

The coronavirus disease (COVID-19) outbreak was first reported in December 2019 in Wuhan, China. Specific information about critically ill COVID-19 patients receiving invasive mechanical ventilation (IMV) is rare.To describe the clinical course and complications of critically ill patients with COVID-19 who received IMV and were successfully weaned from it.This retrospective study included patients admitted to 3 intensive care units (ICUs) and 1 sub-ICU of Renmin Hospital of Wuhan University and Wuhan Jin Yin-tan Hospital between December 24, 2019, and March 12, 2020. Eleven patients who had been diagnosed with critically ill COVID-19 according to the World Health Organization interim guidance, received invasive ventilation, and were finally successfully weaned from it, were enrolled in our study. Their presenting symptoms, comorbidity conditions, laboratory values, ICU course, ventilator parameters, treatments, and relative complications were recorded.Of 108 critically ill COVID-19 patients who received invasive ventilation, 11 patients who underwent tracheal extubation or terminal weaning were included. The mean age of the 11 patients was 52.8 years (range, 38–70 years), 8 (72.7%) were male, and 2 were health care workers. The median time from onset of symptoms to dyspnea was 6.6 days (range, 3–13 days), and the median duration of IMV was 15.7 days (range, 6–29 days). All 11 patients presented with acute severe hypoxemic respiratory failure and received IMV, and 1 patient switched to extracorporeal membrane oxygenation assistance. A lung-protective strategy with lower tidal volume ventilation and proper driving pressure is the main strategy of IMV. All patients had extrapulmonary manifestations, including acute kidney injury, hepatic dysfunction, myocardial damage, and/or lymphopenia. Hospital-acquired infections occurred in 7 (63.6%) patients.Critical COVID-19 illness is characterized by acute hypoxemic respiratory failure and subsequent dysfunction of other organs with a high mortality rate. Correct ventilation strategies and other clinical strategies to improve oxygenation based on the skilled trained group and the availability of equipment are the key methods to rescue lives.     

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??Abstract??Mechanical ventilation is still one of the main treatment measures of acute respiratory distress syndrome (ARDS).From the traditional high tidal volume ventilation (10 ~ 15 mL/kg) to the current use of lung protective ventilation strategies??low tidal volume ventilation (VT)??positive end-expiratory pressure (PEEP)??airway pressure release ventilation (APRV)??bilevel positive airway pressure(BIPAP)??considerable progress has been made.In addition to the well-known conventional mechanical ventilation modes and methods??there are many non-standard mechanical ventilation modes and methods??such as prone position ventilation??neurally adjusted ventilatory assist (NAVA)??extracorporeal membrane oxygenation (ECMO)??high-frequency ventilation and etc.All these measures produce unique effects on the treatment of ARDS.     

Clinical characteristics and determinants of mortality in coronavirus disease 2019 (COVID-19) patients on an intensive care unit—a retrospective explorative 1-year all-comers study

BackgroundClinical outcome in patients with coronavirus disease 2019 (COVID-19) requiring treatment on intensive care units (ICU) remains unfavourable. The aim of this retrospective study was to exploratively identify potential predictors of unfavourable outcome in ICU patients diagnosed with COVID-19.MethodsIn all patients with COVID-19 (n=50) or severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) as comorbidity (n=11) at our ICU we assessed clinical, respiratory and laboratory parameters with a potential role for outcome. Main outcome variables were intubation and mortality rates.ResultsBetween March 2020 and March 2021, 573 patients were hospitalized with SARS-CoV-2 infection. Of these, 61 patients (10.6%, 44.3% women) aged 66.4±13.3 were admitted to ICU. A proportion of 73.8% of patients had moderate or severe acute respiratory distress syndrome (ARDS). COVID-19 patients differed clinically from those with SARS-CoV-2 as comorbidity, such as severe heart or renal failure or sepsis as the leading cause of ICU admission, despite similar mortality rates (44.0% vs. 45.5%, P>0.5). Among COVID-19 patients, those who died had more often severe ARDS (91% vs. 46%, P=0.001), longer non-invasive ventilation (NIV) therapy prior to ICU (6.3±5.9 vs. 2.5±2.0 days, P=0.046), and higher interleukin-6 (IL-6) and lactate dehydrogenase (LDH) values as compared to survivors. In multivariable analysis, NIV duration ≥5 days on admission [odds ratio (OR): 42.20, 95% confidence interval (CI): 1.22 to >99, P=0.038] and IL-6 [OR: 4.08, 95% CI: 1.16–14.33, P=0.028] remained independently predictive of mortality. In worsening tertiles of partial pressure of oxygen (pO₂)/inspiratory oxygen fraction (FiO₂) on admission (≥161.5, 96.5 to <161.5, <96.5) we observed a stepwise increase in intubation rates (P=0.0034) and mortality rates (P=0.031).ConclusionsAs inflammation, ARDS severity and longer NIV duration prior to ICU are associated with intubation and mortality rates, prognosis appears to be largely determined by disease severity. Whether NIV aggravates ARDS or if it indicates lack of recovery independent from type of ventilation, or both should be clarified in a prospective trial.     

Ventilatory strategies in patients with sepsis and respiratory failure

Patients with sepsis may require mechanical ventilation due to the acute respiratory distress syndrome (ARDS). It has become increasingly accepted that mechanical ventilation can contribute to lung injury in these patients. The modern concept of ventilator-induced lung injury is described in the context of alveolar over-distention (volutrauma), alveolar de-recruitment (atelectrauma), and biochemical injury and inflammation to the lung parenchyma (biotrauma). To avoid over-distention lung injury, the tidal volume should be set at 6 mL/kg predicted body weight and plateau pressure should be limited to 30 cm H₂O. This has been shown to afford a survival benefit. Although setting positive end-expiratory pressure (PEEP) to zero is likely harmful during mechanical ventilation of patients with ARDS, evidence is lacking for a survival benefit if a high PEEP level is set compared with a modest level of PEEP. Although adjunctive measures such as recruitment maneuvers, prone position, and inhaled nitric oxide may improve oxygenation, evidence is lacking that these measures improve survival.     

改良的保护性肺通气策略对婴幼儿体外循环术后急性呼吸窘迫综合征的疗效

目的:探讨改良“保护性肺通气策略”的可行性,并评价其对婴幼儿体外循环术后急性呼吸窘迫综合征(ARDS)的治疗效果。方法:对17例先天性心脏病术后合并ARDS的婴幼儿采用新的通气模式:(1)低潮气量(6～8ml/kg);(2)高PEEP(6～12cmH_2O);(3)限制气道峰压(<30～35cmH_2O);(4)高呼吸频率(25～40次/分钟);(5)适当允许高碳酸血症(PaCO_2≤60mmHg)。同时注重液体限制、体位疗法等辅助措施,并在部分危重患儿及时应用外源性肺表面活性物质和(或)一氧化氮。结果:术后平均应用呼吸机时间12.73天。与以往同类病例的治疗结果相比,本组患儿无死亡,并发症发生率降低,无明显后遗症,近远期随访均满意。结论:在改良的保护性肺机械通气的基础上,辅以液体限制、外源性肺表面活性物质、一氧化氮等综合治疗手段,可以明显提高体外循环术后ARDS的治疗效果。     

Comparison between Patients Hospitalized with Influenza and COVID-19 at a Tertiary Care Center

BackgroundWidespread reports suggest the characteristics and disease course of coronavirus disease 2019 (COVID-19) and influenza differ, yet detailed comparisons of their clinical manifestations are lacking.ObjectiveComparison of the epidemiology and clinical characteristics of COVID-19 patients during the pandemic with those of influenza patients in previous influenza seasons at the same hospitalDesignAdmission rates, clinical measurements, and clinical outcomes from confirmed COVID-19 cases between March 1 and April 30, 2020, were compared with those from confirmed influenza cases in the previous five influenza seasons (8 months each) beginning September 1, 2014.SettingLarge tertiary care teaching hospital in Boston, MAParticipantsLaboratory-confirmed COVID-19 and influenza inpatientsMeasurementsPatient demographics and medical history, mortality, incidence and duration of mechanical ventilation, incidences of vasopressor support and renal replacement therapy, and hospital and intensive care admissions.ResultsData was abstracted from medical records of 1052 influenza patients and 582 COVID-19 patients. An average of 210 hospital admissions for influenza occurred per 8-month season compared to 582 COVID-19 admissions over 2 months. The median weekly number of COVID-19 patients requiring mechanical ventilation was 17 (IQR: 4, 34) compared to a weekly median of 1 (IQR: 0, 2) influenza patient (p=0.001). COVID-19 patients were significantly more likely to require mechanical ventilation (31% vs 8%) and had significantly higher mortality (20% vs. 3%; p<0.001 for all). Relatively more COVID-19 patients on mechanical ventilation lacked pre-existing conditions compared with mechanically ventilated influenza patients (25% vs 4%, p<0.001). Pneumonia/ARDS secondary to the virus was the predominant cause of mechanical ventilation in COVID-19 patients (94%) as opposed to influenza (56%).LimitationThis is a single-center study which could limit generalization.ConclusionCOVID-19 resulted in more weekly hospitalizations, higher morbidity, and higher mortality than influenza at the same hospital.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06647-2.Key Words: influenza, COVID-19, mechanical ventilation     

Management of oxygenation in pediatric acute hypoxemic respiratory failure.

The prognosis for patients with acute respiratory distress syndrome (ARDS) in adults and children has improved since its formal acceptance as a clinical entity in 1967. Because acute hypoxemic respiratory failure is the hallmark of acute lung injury and ARDS, the management of oxygenation is crucial. Physicians managing pediatric patients with acute lung injury or ARDS are faced with a complex array of options influencing oxygenation. Certain treatment strategies can influence clinical outcomes, such as a lung-protective ventilation strategy that specifies a low tidal volume (6 mL/kg) and a plateau pressure limit (30 cm H(2)O) (Acute Respiratory Distress Network, N Engl J Med 2000;342:1301-1308). Other lung-protective strategies such as different levels of positive end-expiratory pressure, altered inspiratory:expiratory ratios, recruitment maneuvers, prone positioning, and extraneous gases or drugs may impact clinical outcomes but require further clinical study. This paper reviews state-of-the-art strategies on the management of oxygenation in acute hypoxemic respiratory failure and attempts to guide pediatric pulmonologists in managing children with respiratory failure.     

Tracheostomy for COVID-19 respiratory failure: timing,ventilatory characteristics,and outcomes

BackgroundWhereas data from the pre-pandemic era have demonstrated that tracheostomy can accelerate liberation from the ventilator, reduce need for sedation, and facilitate rehabilitation, concerns for healthcare worker safety have led to disagreement on tracheostomy placement in COVID-19 patients. Data on COVID-19 patients undergoing tracheostomy may inform best practices. Thus, we report a retrospective institutional cohort experience with tracheostomy in ventilated patients with COVID-19, examining associations between time to tracheostomy and duration of mechanical ventilation in relation to patient characteristics, clinical course, and survival.MethodsClinical data were extracted for all COVID-19 tracheostomies performed at a quaternary referral center from April-July 2020. Outcomes studied included mortality, adverse events, duration of mechanical ventilation, and time to decannulation.ResultsAmong 64 COVID-19 tracheostomies (13% of COVID-19 hospitalizations), patients were 64% male and 42% African American, with a median age of 54 (range, 20–89). Median time to tracheostomy was 22 (range, 7–60) days and median duration of mechanical ventilation was 39.4 (range, 20–113) days. Earlier tracheostomy was associated with shortened mechanical ventilation (R²=0.4, P<0.01). Median decannulation time was 35.3 (range, 7–79) days. There was 19% mortality and adverse events in 45%, mostly from bleeding in therapeutically anticoagulated patients.ConclusionsTracheostomy was associated with swifter liberation from the ventilator and acceptable safety for physicians in this series of critically ill COVID-19 patients. Patient mortality was not increased relative to historical data on acute respiratory distress syndrome (ARDS). Future studies are required to establish conclusions of causality regarding tracheostomy timing with mechanical ventilation, complications, or mortality in COVID-19 patients.     

Personalizing mechanical ventilation for acute respiratory distress syndrome

Lung-protective ventilation with low tidal volumes remains the cornerstone for treating patient with acute respiratory distress syndrome (ARDS). Personalizing such an approach to each patient’s unique physiology may improve outcomes further. Many factors should be considered when mechanically ventilating a critically ill patient with ARDS. Estimations of transpulmonary pressures as well as individual’s hemodynamics and respiratory mechanics should influence PEEP decisions as well as response to therapy (recruitability). This summary will emphasize the potential role of personalized therapy in mechanical ventilation.     

急性呼吸窘迫综合征的容许性高碳酸血症的机械通气治疗

急性呼吸窘迫综合合征（ＡＲＤＳ）机械通气治疗的探索。方法观察了１０例ＡＲＤＳ患者。为了减低吸气末气道压力（ｐｐｌａｔ），减少肺气压伤，应用较低的潮气量（ＶＴ，ｘ＝６．５ｍｌ／ｋｇ），依靠自身肾脏代偿功能，容许一定限度的呼吸性酸中毒（简称呼酸）存在（ｐＨ≥７．１９）。在维持动脉血氧分压（ＰａＯ２）７．３ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）左右情况下，尽量使用低水平吸氧浓度（ＦｉＯ２，ｘ＝０．５１）及呼气示正压（ＰＥＥＥＰ，ｘ＝０．９２ｋＰａ）（１ｋＰａ＝１０．２ｃｍＨ２Ｏ）。结果７例存活，其中３例在机械通气期间出现过呼酸，２例出现肺气压伤。结论在ＡＲＤＳ机械通气治疗中，使用较低ＶＴ及容许一定限度呼酸存在是值得重视的新观点，应在临床上进一步探索     

Individualized positive end-expiratory pressure (PEEP) during one-lung ventilation for prevention of postoperative pulmonary complications in patients undergoing thoracic surgery: A meta-analysis

Background:Positive end-expiratory pressure (PEEP) is an important part of the lung protection strategies for one-lung ventilation (OLV). However, a fixed PEEP value is not suitable for all patients. Our objective was to determine the prevention of individualized PEEP on postoperative complications in patients undergoing one-lung ventilation.Method:We searched the PubMed, Embase, and Cochrane and performed a meta-analysis to compare the effect of individual PEEP vs fixed PEEP during single lung ventilation on postoperative pulmonary complications. Our primary outcome was the occurrence of postoperative pulmonary complications during follow-up. Secondary outcomes included the partial pressure of arterial oxygen and oxygenation index during one-lung ventilation.Result:Eight studies examining 849 patients were included in this review. The rate of postoperative pulmonary complications was reduced in the individualized PEEP group with a risk ratio of 0.52 (95% CI:0.37–0.73; P = .0001). The partial pressure of arterial oxygen during the OLV in the individualized PEEP group was higher with a mean difference 34.20 mm Hg (95% CI: 8.92–59.48; P = .0004). Similarly, the individualized PEEP group had a higher oxygenation index, MD: 49.07mmHg, (95% CI: 27.21–70.92; P < .0001).Conclusions:Individualized PEEP setting during one-lung ventilation in patients undergoing thoracic surgery was associated with fewer postoperative pulmonary complications and better perioperative oxygenation.     

ARDSnet ventilatory protocol and alveolar hyperinflation: role of positive end-expiratory pressure

RATIONALE: In patients with acute respiratory distress syndrome (ARDS), a focal distribution of loss of aeration in lung computed tomography predicts low potential for alveolar recruitment and susceptibility to alveolar hyperinflation with high levels of positive end-expiratory pressure (PEEP). OBJECTIVES: We tested the hypothesis that, in this cohort of patients, the table-based PEEP setting criteria of the National Heart, Lung, and Blood Institute's ARDS Network (ARDSnet) low tidal volume ventilatory protocol could induce tidal alveolar hyperinflation. METHODS: In 15 patients, physiologic parameters and plasma inflammatory mediators were measured during two ventilatory strategies, applied randomly: the ARDSnet and the stress index strategy. The latter used the same ARDSnet ventilatory pattern except for the PEEP level, which was adjusted based on the stress index, a monitoring tool intended to quantify tidal alveolar hyperinflation and/or recruiting/derecruiting that occurs during constant-flow ventilation, on a breath-by-breath basis. MEASUREMENTS AND MAIN RESULTS: In all patients, the stress index revealed alveolar hyperinflation during application of the ARDSnet strategy, and consequently, PEEP was significantly decreased (P < 0.01) to normalize the stress index value. Static lung elastance (P = 0.01), plasma concentrations of interleukin-6 (P < 0.01), interleukin-8 (P = 0.031), and soluble tumor necrosis factor receptor I (P = 0.013) were significantly lower during the stress index as compared with the ARDSnet strategy-guided ventilation. CONCLUSIONS: Alveolar hyperinflation in patients with focal ARDS ventilated with the ARDSnet protocol is attenuated by a physiologic approach to PEEP setting based on the stress index measurement.     

肺保护性通气对严重胸外伤致急性呼吸窘迫综合征疗效的影响研究

目的探讨小潮气量（LTV）加呼气末正压（PEEP）机械通气（MV）治疗严重胸外伤致急性呼吸窘迫综合征（ARDS）的疗效。方法以28例常规潮气量（8～12ml/kg）MV为对照组,30例小潮气量（5～7ml/kg）加用PEEP的MV模式为观察组,比较两组血气,RR、HR、MAP、CVP、呼吸机所致肺损伤（VILI）、多脏器功能不全（MODS）发生率及ARDS病死率。结果两组PaO2差异无显著性意义;观察组PaCO2高于对照组;观察组出现6例VILI、4例MODS及死亡3例,对照组13例VILI、7例MODS、死亡5例。结论在ARDS治疗中采用小潮气量加PEEP及允许范围内高碳酸血症（PHC）的肺保护性通气策略,可明显改善缺氧,减少VILI发生,从而降低病死率。