经胸电阻抗成像和重症超声导向的儿童急性呼吸窘迫综合征个体化肺保护通气策略实施

Implementation of individualized lung protective ventilation strategy for pediatrics acute respiratory distress syndrome guided by electrical impedance tomography and critical care ultrasound

目的探讨肺部电阻抗断层成像(electrical impedance tomography,EIT)和重症超声导向的儿童急性呼吸窘迫综合征(pediatric acute respiratory distress syndrome,pARDS)个体化肺保护通气策略的实施。方法回顾性分析1例重度pARDS患儿实施保护性通气策略的治疗过程,在救治过程中采用EIT和重症超声指导保护性通气策略的实施。结果EIT指导肺复张和最佳呼气末正压滴定,重症超声评估pARDS血流动力学和肺部状态,指导右心保护通气和循环保护通气的实施。最终患儿成功救治。结论pARDS保护性通气的理念,已由传统的肺保护通气走向右心保护和循环保护通气的理念,最终达到对肺血管内皮的保护。EIT和重症超声丰富了对pARDS病理生理的认识和对保护性通气的理解。

Objective To explore the implementation of individualized lung protection ventilation strategy in pediatric acute respiratory distress syndrome(pARDS)guided by transthoracic electrical impedance tomography(EIT)and critical care ultrasound(CCU).Methods We retrospectively analyzed the therapeutic process of protective ventilation strategy in one case of severe pARDS.EIT and CCU were used to guide the implementation of lung protective ventilation strategy.Results EIT was used to guide lung recruitment and optimal positive end-expiratory pressure titration.CCU was used to assess hemodynamics and lung status of ARDS patient,and guide the implementation of right ventricular protective ventilation and circulatory protective ventilation.Finally,the patient eventually survived.Conclusion The idea of ARDS protective ventilation has changed from traditional lung protective ventilation to right heart protective ventilation and circulatory protective ventilation,and finally achieved the protection of pulmonary vascular endothelium.EIT and CCU enrich the understanding of the pathophysiology and protective ventilation strategy in pARDS.