경희대 호흡기내과 ACUTE RESPIRATORY DISTRESS SYNDROME (Update 2013) 호흡기내과 박명재

경희대 호흡기내과 1967~2013 PubMED

경희대 호흡기내과 (December 24, 1932 – December 12, 2009)

경희대 호흡기내과 Definition (AECC, 1994)

경희대 호흡기내과 JAMA. 2012;307(23):

경희대 호흡기내과 General Management (1) Recognition and treatment of the underlying medical and surgical disorders (e.g., sepsis, aspiration, trauma) (2) Minimizing procedures and their complications (3) Prophylaxis against venous thromboembolism, GI bleeding, and central venous catheter infections (4) Prompt recognition of nosocomial infections (5) Provision of adequate nutrition.

경희대 호흡기내과 Respiratory Support Goal: maintain sufficient oxygenation and ventilation, minimize complications of ventilatory management

경희대 호흡기내과 Harrison's Principles of Internal Medicine, 17e 18e A C D,C B D

경희대 호흡기내과 low TV (6 mL/kg) vs. conventional TV (12 mL/kg) Mortality low TV (31%) conventional TV (40%)

경희대 호흡기내과 Harrison's Principles of Internal Medicine, 17e 18e A C D,C B D

경희대 호흡기내과 Alveolar Recruitment

경희대 호흡기내과

Harrison's Principles of Internal Medicine, 17e 18e 19e A C D,C B D A C A D,C B D

경희대 호흡기내과 Prone Position

경희대 호흡기내과 Prone Position 2001;345:568-73

경희대 호흡기내과

Harrison's Principles of Internal Medicine, 17e 18e 19e A C D,C B D A C A D,C B D

경희대 호흡기내과 High Frequency Ventilation

경희대 호흡기내과 (MOATII) Am J Respir Crit Care Med. 2002

경희대 호흡기내과

Harrison's Principles of Internal Medicine, 17e 18e 19e A C D,C B D A C A D,C B D

경희대 호흡기내과 Extracorporeal Membrane Oxygenation (ECMO) Zapol WM et al. JAMA 1979;242(20): Prospectively randomized 90 adult patients Multicenter trial –Conventional mechanical ventilation vs. mechanical ventilation supplemented with partial venoarterial bypass –No benefit

경희대 호흡기내과

Harrison's Principles of Internal Medicine, 17e 18e 19e A C D,C B D A C A D,C B D

경희대 호흡기내과 :224,

경희대 호흡기내과

Harrison's Principles of Internal Medicine, 17e 18e 19e A C D,C B D A C A D,C B D

경희대 호흡기내과 24 pts with severe ARDS & failure to improve by day 7 of treatment Placebo vs. MPD 2mg/kg/day for 32 days JAMA 1998;280:159-65

경희대 호흡기내과 87% overall survival 37% overall survival

경희대 호흡기내과 Conclusions These results do not support the routine use of MPD for persistent ARDS despite the improvement in cardiopulmonary physiology. In addition, starting MPD therapy more than 2 weeks after the onset of ARDS may increase the risk of death. N Engl J Med 2006

경희대 호흡기내과 Harrison's Principles of Internal Medicine, 17e 18e 19e A C D,C B D A C A D,C B D

경희대 호흡기내과 Exogenous Surfactant N Engl J Med 2004

경희대 호흡기내과 JAMA. 2005;293:

경희대 호흡기내과 Effects of inhaled nitric oxide in patients with ARDS: Results of a randomized phase II trial Dellinger RP et al. Crit Care Med 1998; 26:15-23 Prospective, randomized, placebo controlled, double blinded, multi-center study 177 adults with ARDS Improvement in oxygenation index No significant differences in mortality or days off ventilator

경희대 호흡기내과 JAMA 2004;291:

경희대 호흡기내과 Phase 2 RCT

경희대 호흡기내과

Effect of Intravenous β-2 Agonist Treatment on Clinical Outcomes in Acute Respiratory Distress Syndrome (BALTI-2) (ALTA) Phase 1 RCT Phase 2 RCT

경희대 호흡기내과 Neutrophil Elastase Inhibition in Acute Lung Injury (STRIVE) Crit Care Med 2004, 1695 A Randomized Clinical Trial of HMG–Co A Reductase Inhibition for Acute Lung Injury (HARP) Am J Respir Crit CareMed 2011, 620 Control Sivelestat (Elaspol) Phase 3 RCT Phase 2 RCT

경희대 호흡기내과

Nebulized Heparin is Associated with Fewer Days of Mechanical Ventilation in Critically Ill Patients: a Randomized Controlled Trial Critical Care 2010, 14:R180 Phase 2 RCT

경희대 호흡기내과 GÉRICAULT – La Balsa de la Medusa(Museo del Louvre,1818)