急性呼吸窘迫综合征的新定义课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,急性呼吸窘迫综合征的新定义,Acute Respiratory Distress Syndrome,The berlin Definition,JAMA, Published online May 21, 2019,急性呼吸窘迫综合征的新定义,1,ARDs概念的转变,THE LANCET,Subscribe I Register I Login,Advanced search,Home I Journals I Specialties I Clinical I Global Health I Audio I Conferences I Information for I Healthcare Jobs,1967年 Ashbaugh第一次提出了成人呼吸窘迫综合征(ARDS),1.呼吸频率增快,2低氧血症,3肺顺应性下降,4常规呼吸支持治疗效果较差,Acute respiratory distress in adults. Lancet. 1967; 2(7511): 319-323,ARDs概念的转变,2,ARDs概念的转变,AMERIGAN JOURNAL OF,Respiratory and Critical Care Medicine,HOME CURRENT SSUE PAST IS5UES ARTICLES IN FRESS SEARCH ToC by E-MAIL SUBSCRIPTIONS CONTACT US HELP SITE MAP,1994年欧美会议共识(AEcC)ARDS诊断标准:,1病程:急性起病,2低氧血症:PaO2FiO2200mmHg,3胸片:双肺弥漫性浸润,4没有左心房高压的证据,PAWP18mmHg,AL|诊断标准:,Pao2Fio2300mmHg,The American-European Consensus Conference on ARDS. Definitions, mechanisms,relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994,ARDs概念的转变,3,AECC诊断标准前局限,氧合指数(PaO2/FiO2)一定是这样吗?,400,日200,100,0,3,Fi02,AECC诊断标准前局限,4,AEcc诊断标准的局限,006,AYD-5im/loOmI,D-smlI0dnl,g I Relation between PaO /FIOx and FIO for a constant arterio-venous difference (AVD)and,i diff,Ee9,De Tml100ml,AVD-5ml100mI,AVD- 3ml 100mI,Relation between PaO2/FlO2 ratio and Flo2: a mathematical description. Intensive Care,Med.2019oct;32(10):14947,AEcc诊断标准的局限,5,Before,After,Standardization Standardization,DI,First day0.35(0.0-0.74)1.00,Any day0.21(0.0-0.59)1.00,consecut048(0.05-0.91)0.63(0.17-1.0),Interobserver variation in interpreting chest radiographs for the diagnosis of acute,respiratory distress syndrome. Am J Respir Crit Care Med 2000; 161: 85-90,Before,6,Table 2. American-European Consensus Conference Definition and Sensitivity, Specificity, and Likelihood Ratios Assessed in Patients,Who Died in the Intensive Care Unit*,allens,Clinical crlterla for ards,燃带带能篮,n Damage, n Damage, n Damage,n,All patients (n=382),94,43,227,(66-82)847983)4.703.56.30.30.204),Patients with rsk factors for ARDS 84,76(67-83)75(6881)30(2.34.0)0310.205),Patients with pulmonary risk factors 27,0270,61(47-74)69(57-79)2019-3.1)0.60408),Patients with extrapulmonary risk 57,85075-92)78(0-95)39(27-5.7)0.20.1-03),*ARDS= acute respiratory distress syndrome,Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy,findings. Ann Intern Med. 2019 Sep 21: 141(6): 440-5,Table 2. American-European Con,7,AEcc诊断标准的局限,AECc标准,AEcc局限性,病程,急性起病,无具体时间,Pao2/Fio2300mmHg误解201900mmHg为AL,氧合指数PaO2Fi025200mmHg,不同的PEEP及Fo2,未考虑PEEP水平,PaO2FO2也不同,胸片,双肺弥漫性浸润,缺乏客观评价指标,PAWP,PAWP18mmHg,无左心ARDS及高水平PAWP可同时存,房高压,在,PAWP有不确定性,危险因素无,未考虑,AEcc诊断标准的局限,8,JAMA Mo douma,an Medical Association,Home Current Issue All lssues Online First Specialties Topics CME Multimedia Quizzes For Authors Store,ONLINE FIRST,Acute Respiratory Distress Syndrome,The berlin definition,The ards Definition Task Force,The acute respiratory distress,me(ARDS)was defined in 1994 by,ALID AND RELIABLE DEFIN,tions are es,American-European Consensus Conference(AECC); since then, issues regard-,iological stud- ing the reliability and validity of this definit,Using a con-,ies successfully and to sensus process, a panel of experts convened in 2019(an initiative of the Eu-,acilitate enrollment of a consistent pa- ropean Society of Intensive Care Medicine endorsed by the American Thoraci,tient phenotype into clinical trials. Cli- Society and the Society of Critical Care Medicine) developed the Berlin Defi,nicians also need such definitions to nition, focusing on feasibility, reliability, validity, and objective evaluation,implement the results of clinical trials, its performance. a draft definition proposed 3 mutually exclusive categories,discuss prognosis with families, and of ARDS based on degree of hypoxemia: mild (200 mm HgPao/FiO2s300,plan resource allocation,mm Hg). moderate(100 mm Hg Pao,/FlO 200 mm Hg), and severe(Pao,/,JAMA Mo douma,9,AEcc标准,The Berlin Definition,病程,急性起病,确定具体时间,ALl,PaO2Fo25300mmHg是否有更科学的分类,氧合指数,Pao2/Fio2200mmHg,未考虑PEEP水平,将机械通气状态考虑进来,胸片,双肺弥漫性浸润,是否有更加量化的指标,PAWP,PAWPS18mmHg,无左心房,高压,PAWP还用考虑吗?,危险因素无,考虑进来,AEcc标准,10,急性呼吸窘迫综合征的新定义课件,11,急性呼吸窘迫综合征的新定义课件,12,急性呼吸窘迫综合征的新定义课件,13,急性呼吸窘迫综合征的新定义课件,14,急性呼吸窘迫综合征的新定义课件,15,急性呼吸窘迫综合征的新定义课件,16,急性呼吸窘迫综合征的新定义课件,17,急性呼吸窘迫综合征的新定义课件,18,急性呼吸窘迫综合征的新定义课件,19,急性呼吸窘迫综合征的新定义课件,20,急性呼吸窘迫综合征的新定义课件,21,急性呼吸窘迫综合征的新定义课件,22,