主动循环呼吸技术(active cycle of breathing technique,ACBT)是一种有明确技术标准的呼吸锻炼技术,需要患者的主动参与,对场地设备无要求,操作灵活,易于实现,具有一定的优势。ACBT作为呼吸道管理技术,目前已被用于肺囊性纤维化、慢性...主动循环呼吸技术(active cycle of breathing technique,ACBT)是一种有明确技术标准的呼吸锻炼技术,需要患者的主动参与,对场地设备无要求,操作灵活,易于实现,具有一定的优势。ACBT作为呼吸道管理技术,目前已被用于肺囊性纤维化、慢性阻塞性肺疾病等治疗[1],研究表明ACBT可以改善呼吸肌功能、动脉血气水平、改善呼吸困难和生活质量[2]。在机械通气期间,实施呼吸肌功能锻炼,有助于早日脱机[3]。目前,ACBT较多应用于非机械通气患者,患者有意识地进行ACBT呼吸锻炼在机械通气患者中的应用价值仍需进一步探讨。基于此,本次研究ACBT在自主呼吸测试期间的机械通气患者治疗中的临床应用研究。现报道如下。展开更多
Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the c...Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve . Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended . The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evidence-based recommendations can be made regarding many aspects of the acute management of ALI/ARDS that will hopefully translate into improved outcomes for the critically ill patient. The guidelines will be updated when some important new knowledge becomes available.展开更多
文摘主动循环呼吸技术(active cycle of breathing technique,ACBT)是一种有明确技术标准的呼吸锻炼技术,需要患者的主动参与,对场地设备无要求,操作灵活,易于实现,具有一定的优势。ACBT作为呼吸道管理技术,目前已被用于肺囊性纤维化、慢性阻塞性肺疾病等治疗[1],研究表明ACBT可以改善呼吸肌功能、动脉血气水平、改善呼吸困难和生活质量[2]。在机械通气期间,实施呼吸肌功能锻炼,有助于早日脱机[3]。目前,ACBT较多应用于非机械通气患者,患者有意识地进行ACBT呼吸锻炼在机械通气患者中的应用价值仍需进一步探讨。基于此,本次研究ACBT在自主呼吸测试期间的机械通气患者治疗中的临床应用研究。现报道如下。
文摘Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve . Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended . The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evidence-based recommendations can be made regarding many aspects of the acute management of ALI/ARDS that will hopefully translate into improved outcomes for the critically ill patient. The guidelines will be updated when some important new knowledge becomes available.
