保护性肺通气.pdf

A History of Tidal Volume 1960s 12~15ml/kg, peek>30cmH2O 1970s High pressures and volumes can cause lung damage 1994 A Consensus Conference on MV concluded that large VTs damage the lung .Little change in ventilator practice 2000 The ARDS Network trial demonstrated unequivocally that ventilating patients with 6 ml/kg predicted body weight(PBW ) saves human lives anaesthesiologists started to apply the concept of“protective ventilation” --low VT and PEEP ? Low VT and PEEP Recruitment Maneuvers(RMs) improve the effectiveness of PEEP Low VT +PEEP+RMs Liu Bing Lower VT+higher PEEP+RMS (Protective ventilation strategy) Higher VT+ZEEP (Standard ventilation strategy) Modified Clinical Pulmonary Infection Score Gas exchange Chest x-ray pulmonary functional tests age >18 general anaesthesia (GA)  nonlaparoscopic abdominal surgery mechanical ventilation  BMI>40kg/m2 emergency  previous lung surgery or lung disease  any other systematic disease Epidural anesthesia F 1~3ug/kg P2~3mg/kg R0.8mg/kg induction P5~10mg/kg.h or sevo 1.5%~2%+ Remi0.05~0.3ug/kg.min maintenance Ventilation Protocol I:E=1:2, respiratory rate adjusted to normocapnia S 9 ml/kg ideal body weight (IBW) and ZEEP P 7 ml/kg IBW and 10 cm H2O PEEP with RMs IBW 50 + 0.91(height [cm] −152.4) for men 45.5 + 0.91 (height [cm]−152.4) for women (After induction of anesthesia, in hemodynamic stable situation) RMs were performed in volume-controlled ventilation as follows: the limit of peak inspiratory pressure was initially set at 45 cm H2O,the tidal volume at 7 ml/kg IBW, and respiratory rate at 6 breaths/min, PEEP at 10 cm H2O, and the inspiratory to expiratory ratio at 3:1; then the tidal volume was increased in steps of 4 ml/kg IBW until plateau pressure reached 30 cm H2O and three breaths were allowed. Results Results Results Results Results A protective ventilation strategy during abdominal surgery lasting more than 2h improved respiratory function and reduced the modified Clinical Pulmonary Infection Score without affecting length of hospital stay. NOT Just a trail