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ARDS

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Title: ARDS Author: ghaem Last modified by: ghaem Created Date: 12/27/2006 8:39:35 PM Document presentation format: On-screen Show Company: mums Other titles – PowerPoint PPT presentation

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Title: ARDS


1
ARDS
Dr. R. Bagheri Assistant professor of thoracic
surgery MUMS
2
  • ?? ????? ???? Adult .R.D.S ?????? ?? ??. ?? ??
    ????? ????? ???? ?? ???????? ??? ?? ?? ????
    ????????? ??? ????? ???? ? ?? CXR ??? ????? ??
    ???? ???????????? ????? ?? ???? ?????? ?? ???? ?
    ???? ???? ??? ?? ??? ???? .

3
???????? ARDS
  1. ???? ??? ?????
  2. ?????? ?? ???? ?? CXR
  3. Pul.art.occ.prelt18mm/Hg
  4. Pao2/FIO2lt2oo mm/Hg (????????????? ?? ????? ???
    ??????? ??? ????? ?? 24h ???)

4
Out come
  • ?????? ????? ?? ??? (40-80 ) ? ?????? ?????? ??
    ?? ?? 20y ???? ????? ????? ???.
  • ????? ???? ?? ?????????
  • ??? ????? ?? ???? ARDS
  • ????? ????? ? ?????? ????? ??? ?? ????? ?? ARDS
  • Age
  • ???? ??? ???? ??? 72h ?? ???? ?? ?? ??? ??????
    ????? ?????? ??? ??? ??? ?? ???? ???? ?? Sepsis
    ?MOF ?? ???? .(??? ?? ????? ???? ??? MOF ??????
    ?? ??????? ????? ????? ?? ????? )

5
??? ????? ?????
  • Direct injury
  • ???) ??? ???? ???????? ??? ????????? ???????
    ???? ????? ????
  • ?) ??? ?????? ??????? ?????? ??? ??? ???
  • Indirect injury
  • ???) ??? ???? Sepsis ?????? ????? ? ????
    ??? ?????? ???
  • ?) ??? ?? ???? ??????????? ????? ??? ???
    ???? ? ????
  • ?? ???????? ????? ????? ???? ??? ????? ?????
  • ???? ??? ?? 2 ?? 3 ???? ??????
  • ????? ??? ???? ???? 29ltApacheII

6
  • Direct injury
    Indirect injury
  • Common Pathway
  • ?????????? ??????? 1- ??????
    ????????? ?????? ????
  • - ???????? 2- ?????? ????
    ???? ????
  • - ?????? 3- ??? IS ?
    ???? ???????
  • - ?????????
  • Alter the integrity of the
    alveolar-Capillary membrane

7
Management
  • ???? ??? ????? ????? ????? ??? ? ??? ???????? ???
    ARDS ??? Sepsis ?? ???? ???? ?? ??? ?? ?? ?????
    ???.

8
Management
  • ????? ?????
  • ????? ?????????
  • ???) Less TV ( 6-10cc/kg )
  • ?) PIP 40-45cm/H2O
  • ?) FIO2 60 ?? ????
  • ?) ??????? ?? PEEP ?? ????? (??? ??????? ??
    ???????? ? ?????? FRC ? ????? ????)
  • ???? ?????? ?? ??? ???? ?? ???? ???? ??? ??
    ??????
  • ????? ???? ?? ??? ? ???? ??? ??? ???? ??????
    ?????
  • ???? ?? ????????? ??? ????????? ??? ??? .

9
????? ??? ??? ????????? ?? ARDS
  • Permissive hypercapnea ?? ??????????? ?????
    ?? ???? 100 ??80 Paco2 ?? ?? ???? ????? ??
    ????? ????? ???? ?? ?? ???? ???? ? ????? ?????
    ???? ? ???? ??? ?? ???? PHlt7.1 ???? ?? ????? ??
    ?? ?????? ???? .
  • ??????????????? ???? CNS ?? ???? ???? co2
    ???????? ?????? ICP ?? ????.

10
  1. Inverse Ratio Ventilation (IRV ) ?? ???? ????
    I/E1/2 ??? ?? ??? ??????? ?? ?? ?? 2/1 ?? 3/1 ??
    ?????? ???? ???? ????? ?????????? ? ???????????
    ?? ?????? ???? ?? ?? ??? .
  2. High Frequency Ventilation ?? (2 cc/kg TV1- )?
    ?? 600ltRatelt3600 ?? ????? ?????????? ????? ??
    ???.
  3. ????? ?????????
  4. ??????? ?? ?????? ????? ???????? ?????????????
    ??????? ???? ??? ??? ?? ??????? ??? ?? ?????? ???.

11
ECMO
  • ???? ??? ???? ?? ??????? ????? ????? ?? ????? ??
    ???? .

12
???? ?????? ?? ??? ?????
  • Partial liquid lung ventilation
  • ?? ???? Per flurocarbone ??????? ?? ??? ??
    ????? ??????????? ?? ?? ????? ????????? ? ???? (
    ???? Surface Tension ) ???? ?? ???? .
  • ??????? ?? ???? ?? ??????? ?????????? Vit E
    ????????? ??????? ?......
  • ???? ????? ?? ??? ??? ?????? ????? ??? ?? ?? ??
    ??? ???? ???? ???????? ?? ???? . (1w??? ??
    ?????????? ? ?? ???? ????? )
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