急性呼吸困难综合征:诊断和治疗方面的进展
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
概括
急性呼吸困难综合征 (ARDS) 诊断的进展包括柏林定义,改善死亡率预测. 管理重点是肺部保护性通风,倾斜的位置显示死亡率好处,而药物治疗仍然无效.
科学领域:
- 危急护理医学
- 肺病学
- 呼吸系统医学
背景情况:
- 急性呼吸困难综合征 (ARDS) 是一种严重的呼吸衰竭,影响全球数百万人的急性呼吸困难综合症,急性呼吸困难综合症的入院率和死亡率很高.
- 了解最近的诊断和治疗进展对于改善ARDS患者的结果至关重要.
研究的目的:
- 审查过去五年急性呼吸困难综合征 (ARDS) 诊断和治疗方面的重大进展.
- 综合临床试验和指导方针的证据,以提供当前ARDS管理的信息.
主要方法:
- 从2012年到2017年,主要数据库 (MEDLINE,EMBASE,Cochrane) 进行了全面的文献搜索.
- 专注于随机临床试验,元分析,系统审查和与ARDS诊断和治疗相关的临床实践指南.
- 在选了1600多个引用以寻找重大进展后,选出了31篇文章.
主要成果:
- 与之前的标准相比,柏林定义增强了基于低氧症严重性的ARDS分类,改善了死亡率预测.
- 肺部保护的机械通风策略,包括倾斜的位置,在特定的ARDS群体中显示出显著的死亡率益处.
- 针对ARDS病理生理学的几种药物疗法显示没有益处和潜在危害,这强调了支持性护理的重要性.
结论:
- 柏林定义为ARDS诊断提供了更强大的框架,尽管某些标准的可靠性需要注意.
- 目前的管理层强调支持性护理与肺部保护性机械通风,以最近基于证据的建议为指导.
- 对于ARDS的有效药物治疗仍然难以捉摸,这凸显了对潜在机制的持续研究的需要.
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