PiCCO技术在ARDS诊断和治疗中的应用

Case report: 腹痛伴恶心呕吐腹痛伴恶心呕吐4天天血常规： WBC 3.6109/L GRA 25% PLT 35109/L血气：pH 7.429 PO2 86.4mmHg (FiO2 50%) Lac 6.5mmol/L生化： ALB 15g/L CR 330umol/L心电图：窦性心律, ST-T异常急性呼吸衰竭的病因?N Engl J Med 2005;353:2788-96Am J Respir Crit Care Med, 1994,149:818-824缺乏反映其病理生理特征的血管通透性指标缺乏反映其病理生理特征的血管通透性指标对于有基础心脏病史，合并感染、休克时鉴别诊断非常困难对于有基础心脏病史，合并感染、休克时鉴别诊断非常困难ARDS vs cardiogenic pul edema该患者可能因素？该患者可能因素？ Intensive Care Med, 2002,28(8):1073-7N Engl J Med 2006,354:2213-24n 29 pats ：PAWP 18mm Hgn 97% pats with PAWP 18mm Hg had a normal or elevated CI1001 patients, 513 assigned to PAC, 488 to CVCSchuster DP. The search for “objective” criteria for ARDS. Intensive Care Med, 2007, 33:400-402.Ware LB,. Matthay MA. Acute Pulmonary Edema. N Engl J Med, 2005;353:2788-96.Schuster DP, Stark T, Stephenson J, et al. Detecting lung injury in patients with pulmonary edema. Intensive Care Med, 2002, 28: 1246-1253. 肺水指标：肺水指标： Extravascular Lung Water: EVLW Pulmonary Vascular Permeability Index: PVPI (EVLW/PBV)EVLWi/GEDVi 3.01021.2102 1.41020.4102*Cut-off value = 3 Se=85% Sp=100%ROC-PVPI: 0.920.04Critical Care 2006, 10(Suppl 1):P326 Management of ARDSCrit Care Med. 2004; 32:691699.Crit Care Med 2004; 32:691699n择期心脏手术患者n=20n监测 GEDVI: PiCCO CEDVIPAC: PAC LV preload assessment: TEEnHemodynamic measurements: before (T0) and 20 min (T1) and 40 min (T2) after a volume loadnVolume load: HES10 ml/kg over 20minBritish Journal of Anaesthesia. 2005, 94 (6): 748755.British Journal of Anaesthesia 94 (6): 74855 (2005)40 patients undergoing elective OPCABGChest 2005, 128:848854nSVV 、 GEDV、ITBV: Cardiac preload Circ Res 1959, 7: 649-57Management of ARDS拔管失败可能的原因？拔管失败可能的原因？Management of ARDS6-076-10期间负平衡1500ml1000ml/d6-11 EVLWI 6ml/kg 成功脱机成功脱机Management of ARDS