急性呼吸窘迫综合征及呼吸支持理念:2019年的反思与进步

Acute respiratory distress syndrome and mechanical ventilation concept:rethinking and progress in 2019

急性呼吸窘迫综合征(ARDS)是临床常见的危重症,目前针对肺保护性通气及避免肺损伤的呼吸支持策略的优化仍未对ARDS患者预后产生实质的改善。2019年ARDS的诊断和治疗理念仍在不断的更新,主要包括对“肺开放”和“肺休息”以及神经肌肉阻滞剂应用的反思、发生ARDS预测指标、机械功与ARDS患者预后及脱机模式对脱机预后的影响等。目前的进展表明ARDS临床特征及治疗反应的异质性仍被忽略,结合信息技术及大数据分析的发展,推动实现ARDS精准化治疗是未来的方向。

Acute respiratory distress syndrome(ARDS)is a clinically common critical illness.However,optimization of respiratory support strategies for protective lung ventilation and avoiding lung injury has not yet resulted in a substantial improvement in the prognosis of ARDS patients.The concepts of diagnosis and treatment of ARDS have been updated in 2019,which include"open lung strategy"and"close lung strategy",application of neuromuscular blockers,predictors of occurrence of ARDS,mechanical power,prognosis of patients with ARDS,and the impact of ventilation mode on weaning prognosis.The current progress indicates that the clinical characteristics and the heterogeneity of treatment response of ARDS are still being ignored.Combining the development of information technology and big data analysis could promote the precise treatment of ARDS in the future.