[Acute respiratory distress syndrome].
Identifieur interne : 000130 ( Main/Exploration ); précédent : 000129; suivant : 000131[Acute respiratory distress syndrome].
Auteurs : Elisa Estenssoro [Argentine] ; Arnaldo Dubin [Argentine]Source :
- Medicina [ 0025-7680 ]
Descripteurs français
- KwdFr :
- Curarisants (usage thérapeutique), Décubitus ventral (MeSH), Facteurs de risque (MeSH), Hormones corticosurrénaliennes (usage thérapeutique), Humains (MeSH), Oxygénation extracorporelle sur oxygénateur à membrane (MeSH), Positionnement du patient (méthodes), Pronostic (MeSH), Syndrome de détresse respiratoire de l'adulte (imagerie diagnostique), Syndrome de détresse respiratoire de l'adulte (mortalité), Syndrome de détresse respiratoire de l'adulte (thérapie), Syndrome de détresse respiratoire de l'adulte (étiologie), Tomodensitométrie (MeSH), Ventilation artificielle (méthodes), Ventilation à pression positive (méthodes).
- MESH :
- imagerie diagnostique : Syndrome de détresse respiratoire de l'adulte.
- mortalité : Syndrome de détresse respiratoire de l'adulte.
- méthodes : Positionnement du patient, Ventilation artificielle, Ventilation à pression positive.
- thérapie : Syndrome de détresse respiratoire de l'adulte.
- usage thérapeutique : Curarisants, Hormones corticosurrénaliennes.
- étiologie : Syndrome de détresse respiratoire de l'adulte.
- Décubitus ventral, Facteurs de risque, Humains, Oxygénation extracorporelle sur oxygénateur à membrane, Pronostic, Tomodensitométrie.
English descriptors
- KwdEn :
- Adrenal Cortex Hormones (therapeutic use), Extracorporeal Membrane Oxygenation (MeSH), Humans (MeSH), Neuromuscular Blocking Agents (therapeutic use), Patient Positioning (methods), Positive-Pressure Respiration (methods), Prognosis (MeSH), Prone Position (MeSH), Respiration, Artificial (methods), Respiratory Distress Syndrome, Adult (diagnostic imaging), Respiratory Distress Syndrome, Adult (etiology), Respiratory Distress Syndrome, Adult (mortality), Respiratory Distress Syndrome, Adult (therapy), Risk Factors (MeSH), Tomography, X-Ray Computed (MeSH).
- MESH :
- chemical , therapeutic use : Adrenal Cortex Hormones, Neuromuscular Blocking Agents.
- diagnostic imaging : Respiratory Distress Syndrome, Adult.
- etiology : Respiratory Distress Syndrome, Adult.
- methods : Patient Positioning, Positive-Pressure Respiration, Respiration, Artificial.
- mortality : Respiratory Distress Syndrome, Adult.
- therapy : Respiratory Distress Syndrome, Adult.
- Extracorporeal Membrane Oxygenation, Humans, Prognosis, Prone Position, Risk Factors, Tomography, X-Ray Computed.
Abstract
Acute respiratory distress syndrome (ARDS) is an acute respiratory failure produced by an inflammatory edema secondary to increased lung capillary permeability. This causes alveolar flooding and subsequently deep hypoxemia, with intrapulmonary shunt as its most important underlying mechanism. Characteristically, this alteration is unresponsive to high FIO2 and only reverses with end-expiratory positive pressure (PEEP). Pulmonary infiltrates on CXR and CT are the hallmark, together with decreased lung compliance. ARDS always occurs within a week of exposition to a precipitating factor; most frequently pneumonia, shock, aspiration of gastric contents, sepsis, and trauma. In CT scan, the disease is frequently inhomogeneous, with gravitational infiltrates coexisting with normal-density areas and also with hyperaerated parenchyma. Mortality is high (30-60%) especially in ARDS associated with septic shock and neurocritical diseases. The cornerstone of therapy lies in the treatment of the underlying cause and in the use mechanical ventilation which, if inappropriately administered, can lead to ventilator-induced lung injury. Tidal volume = 6 ml/kg of ideal body weight to maintain an end-inspiratory (plateau) pressure = 30 cm H2O ("protective ventilation") is the only variable consistently associated with decreased mortality. Moderate-to-high PEEP levels are frequently required to treat hypoxemia, yet no specific level or titration strategy has improved outcomes. Recently, the use of early prone positioning in patients with PaO2/FIO2 = 150 was associated with increased survival. In severely hypoxemic patients, it may be necessary to use adjuvants of mechanical ventilation as recruitment maneuvers, pressure-controlled modes, neuromuscular blocking agents, and extracorporeal-membrane oxygenation. Fluid restriction appears beneficial.
PubMed: 27576283
Affiliations:
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This causes alveolar flooding and subsequently deep hypoxemia, with intrapulmonary shunt as its most important underlying mechanism. Characteristically, this alteration is unresponsive to high FIO2 and only reverses with end-expiratory positive pressure (PEEP). Pulmonary infiltrates on CXR and CT are the hallmark, together with decreased lung compliance. ARDS always occurs within a week of exposition to a precipitating factor; most frequently pneumonia, shock, aspiration of gastric contents, sepsis, and trauma. In CT scan, the disease is frequently inhomogeneous, with gravitational infiltrates coexisting with normal-density areas and also with hyperaerated parenchyma. Mortality is high (30-60%) especially in ARDS associated with septic shock and neurocritical diseases. The cornerstone of therapy lies in the treatment of the underlying cause and in the use mechanical ventilation which, if inappropriately administered, can lead to ventilator-induced lung injury. Tidal volume = 6 ml/kg of ideal body weight to maintain an end-inspiratory (plateau) pressure = 30 cm H2O ("protective ventilation") is the only variable consistently associated with decreased mortality. Moderate-to-high PEEP levels are frequently required to treat hypoxemia, yet no specific level or titration strategy has improved outcomes. Recently, the use of early prone positioning in patients with PaO2/FIO2 = 150 was associated with increased survival. In severely hypoxemic patients, it may be necessary to use adjuvants of mechanical ventilation as recruitment maneuvers, pressure-controlled modes, neuromuscular blocking agents, and extracorporeal-membrane oxygenation. Fluid restriction appears beneficial. </div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">27576283</PMID><DateCompleted><Year>2017</Year><Month>02</Month><Day>16</Day></DateCompleted><DateRevised><Year>2017</Year><Month>02</Month><Day>16</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0025-7680</ISSN><JournalIssue CitedMedium="Print"><Volume>76</Volume><Issue>4</Issue><PubDate><MedlineDate>2016</MedlineDate></PubDate></JournalIssue><Title>Medicina</Title></Journal><ArticleTitle>[Acute respiratory distress syndrome].</ArticleTitle><Pagination><MedlinePgn>235-41</MedlinePgn></Pagination><Abstract><AbstractText>Acute respiratory distress syndrome (ARDS) is an acute respiratory failure produced by an inflammatory edema secondary to increased lung capillary permeability. This causes alveolar flooding and subsequently deep hypoxemia, with intrapulmonary shunt as its most important underlying mechanism. Characteristically, this alteration is unresponsive to high FIO2 and only reverses with end-expiratory positive pressure (PEEP). Pulmonary infiltrates on CXR and CT are the hallmark, together with decreased lung compliance. ARDS always occurs within a week of exposition to a precipitating factor; most frequently pneumonia, shock, aspiration of gastric contents, sepsis, and trauma. In CT scan, the disease is frequently inhomogeneous, with gravitational infiltrates coexisting with normal-density areas and also with hyperaerated parenchyma. Mortality is high (30-60%) especially in ARDS associated with septic shock and neurocritical diseases. The cornerstone of therapy lies in the treatment of the underlying cause and in the use mechanical ventilation which, if inappropriately administered, can lead to ventilator-induced lung injury. Tidal volume = 6 ml/kg of ideal body weight to maintain an end-inspiratory (plateau) pressure = 30 cm H2O ("protective ventilation") is the only variable consistently associated with decreased mortality. Moderate-to-high PEEP levels are frequently required to treat hypoxemia, yet no specific level or titration strategy has improved outcomes. Recently, the use of early prone positioning in patients with PaO2/FIO2 = 150 was associated with increased survival. In severely hypoxemic patients, it may be necessary to use adjuvants of mechanical ventilation as recruitment maneuvers, pressure-controlled modes, neuromuscular blocking agents, and extracorporeal-membrane oxygenation. Fluid restriction appears beneficial. </AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Estenssoro</LastName><ForeName>Elisa</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Servicio de Terapia Intensiva, Hospital Interzonal de Agudos General San Martín, Argentina.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dubin</LastName><ForeName>Arnaldo</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Buenos Aires, Argentina. E-mail: arnaldodubin@gmail.com.</Affiliation></AffiliationInfo></Author></AuthorList><Language>spa</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><VernacularTitle>Síndrome de distrés respiratorio agudo.</VernacularTitle></Article><MedlineJournalInfo><Country>Argentina</Country><MedlineTA>Medicina (B Aires)</MedlineTA><NlmUniqueID>0204271</NlmUniqueID><ISSNLinking>0025-7680</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000305">Adrenal Cortex Hormones</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D009466">Neuromuscular Blocking Agents</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000305" MajorTopicYN="N">Adrenal Cortex Hormones</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015199" MajorTopicYN="N">Extracorporeal Membrane Oxygenation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009466" MajorTopicYN="N">Neuromuscular Blocking Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D056888" MajorTopicYN="N">Patient Positioning</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011175" MajorTopicYN="N">Positive-Pressure Respiration</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011379" MajorTopicYN="N">Prognosis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016684" MajorTopicYN="N">Prone Position</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012121" MajorTopicYN="N">Respiration, Artificial</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012128" MajorTopicYN="N">Respiratory Distress Syndrome, Adult</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014057" MajorTopicYN="N">Tomography, X-Ray Computed</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">ARDS</Keyword><Keyword MajorTopicYN="N">PEEP</Keyword><Keyword MajorTopicYN="N">mechanical ventilation</Keyword><Keyword MajorTopicYN="N">prone positioning</Keyword><Keyword MajorTopicYN="N">protective ventilation</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2016</Year><Month>8</Month><Day>31</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2016</Year><Month>9</Month><Day>1</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2017</Year><Month>2</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">27576283</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Argentine</li></country></list><tree><country name="Argentine"><noRegion><name sortKey="Estenssoro, Elisa" sort="Estenssoro, Elisa" uniqKey="Estenssoro E" first="Elisa" last="Estenssoro">Elisa Estenssoro</name></noRegion><name sortKey="Dubin, Arnaldo" sort="Dubin, Arnaldo" uniqKey="Dubin A" first="Arnaldo" last="Dubin">Arnaldo Dubin</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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