急性肺损伤/急性呼吸窘迫综合征的困惑与思考

Confusion and thinking of acute lung injury /acute respiratory distress syndrome

急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）的认识和治疗虽然已经取得长足的进展,但目前对ALI/ARDS的诊断及治疗仍有较多的困惑,值得思考.诊断方面虽有诊断标准,但仍待改进.治疗方面也存在争议： ①保护性通气策略中潮气量与平台压,哪项更为重要？②最佳呼气末正压（PEEP）的选择,争论已久,尚无定论？③肺复张是否真正有效？④肺水管理：限制性液体策略还是开放性液体策略？

Although the recognition and treatment of acute lung injury （ALI）/acute respiratory distress syndrome （ARDS） has made great progress, there is still more confusion in the diagnosis and treatment of ALI/ARDS, which is worth thinking about. Although there is diagnostic criteria, it is to be improved ; also there is dispute in treatment as the foUowing： （~Which is more important in protective ventilation strategy , tidal volume or plateau pressure？ @The argument about optimum PEEP is still inconclusive; @Is lung recruitment really effective？ @Open or limited fluid strategy in lung water management？