急性 呼吸 阻害 症候群: 診断 と 治療 の 進歩
Eddy Fan1,2,3,4, Daniel Brodie5, Arthur S Slutsky1,4,6
1Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
JAMA
|February 22, 2018
まとめ
急性呼吸器障害症候群 (ARDS) の診断における進歩には,死亡率の予測を改善するベルリンの定義が含まれています. マネジメントは肺を保護する換気に重点を置いていますが,薬剤療法が効果的でない一方で,死亡率の利点を示す傾向があります.
科学分野:
- クリティカル ケア 医療
- 肺科
- 呼吸器医学
背景:
- 急性呼吸器障害症候群 (ARDS) は,世界中で何百万人にも及ぶ重症呼吸器障害であり,集中治療室での入院と死亡率は高い.
- 最近の診断と治療の進歩を理解することは,ARDSの患者のアウトカムを改善するために不可欠です.
研究 の 目的:
- 過去5年間の急性呼吸器障害症候群 (ARDS) の診断と治療における重要な進歩をレビューする.
- 臨床試験とガイドラインから得られた証拠を集約し,現在のARDS管理に役立つようにする.
主な方法:
- 2012年から2017年まで,主要なデータベース (MEDLINE,EMBASE,Cochrane) で包括的な文献検索が行われました.
- ランダム化臨床試験,メタ解析,体系的なレビュー,ARDSの診断と治療に関連する臨床実務ガイドラインに焦点を当てた.
- 大事な進歩のために1600以上の引用をスクリーニングした後,31の論文が選択されました.
主要な成果:
- ベルリンの定義は,低酸素症の重度に基づくARDS分類を強化し,以前の基準と比較して死亡率の予測を改善しました.
- 肺を保護する機械呼吸器の戦略は,特定のARDS集団における死亡率の有意な改善を示した.
- ARDSの病理生理学を標的としたいくつかの薬理療法では,利益と潜在的な害が示されず,サポートケアの重要性を強調した.
結論:
- ベルリンの定義は,特定の基準の信頼性には注意が必要ですが,ARDS診断のより堅固な枠組みを提供します.
- 現在の管理は,最近の証拠に基づいた勧告に基づいて,肺を保護する機械的換気によるサポートケアを強調しています.
- ARDSの効果的な薬学的な治療法は未だに難解であり,その背後にあるメカニズムへの継続的な研究が必要であることを強調しています.
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