(2006) ,A RD S. AL Ig A RD S. AL IgA RD S A RD S A RD S A RD S , A RD S 25% 50%, 11% 25%, 9% 26% 1 AL IgARD S , A RD S 50% 6815%

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706 g (2006) Guidel ines for managem en t of acute lung in jurygacute resp ira tory d istress syndrom e: an ev idence- ba sed update by the Ch inese Soc iety of Cr itical Care M edic ine (2006) Ch

1 706 g (2006) Guidel ines for managem en t of acute lung in jurygacute resp ira tory d istress syndrom e: an ev idence- ba sed update by the Ch inese Soc iety of Cr itical Care M edic ine (2006) Ch inese S ociety of C ritical Care M ed icine, Ch inese M ed ical A ssociation Corresp ond ing au thors: Q IU H ai2bo (D ep artm ent of C ritical Care M ed icine, N anj ing Z hong d a H osp ital, S ou th2e ast U niversity, N anj ing , J iang su, Ch ina. Em ail: y ahoo. com. cn ) and L IU D a2w ei (D ep artm ent of C ritical Care M ed icine, P ek ing U nion M ed ical Colleg e H osp ital, Ch inese M ed ical S cience A cad em y, B eij ing , Ch ina. Em ail: dw liu@m edm ail. com. cn or dw liu@p um ch. cn) Abstract Objective In 2006, Ch inese critical care experts drafted m anagem ent guidelines fo r diagno sis and therapy of acute lung injury (AL I) gacute resp irato ry distress syndrom e (A RD S), that w ould be of p ractical use fo r the clinician, and th is effo rt m ay serve to increase nationw ide aw areness and to imp rove the treatm ent result of AL IgA RD S. M ethods T he p rocess included a modified D elph i m ethod, a consensus conference, several sub sequen t sm aller m eetings of subgroup s and key individuals, teleconferences, and electron ic based discu ssion am ong subgroup s and am ong the en tire comm ittee. T he m odified D elph i m ethodo logy u sed fo r grading recomm endation s w as derived from a 2001 pub lication spon so red by the In ternational Sep sis Fo rum. A system atic review of the literatu re w as undertook, and the repo rted resu lts w ere graded into five levels to create recomm endation grading from A to E, w ith a being the h ighest grade. Results It is essential to contro l the p rim ary disease in AL IgA RD S. Ro le of noninvasive po sitive2p ressure ven tilation in AL IgA RD S is undefined. N on invasive po sitive2p ressu re ven tilation can no t be con sidered in patients w ith com a, shock and dam age of airw ay clearance. L im itation of end2insp irato ry p lateau p ressure is impo rtant in the m anagem ent of A RD S and m ay be facilitated by perm issive hypercapnia. R ecruitm ent m aneuver shou ld be con sidered to open co llap sed lung and im p rove oxygenation. A m in im um am oun t of po sitive end2exp irato ry p ressure (PEEP) should be set to p revent atelectasis at end exp iration in A RD S. If it is po ssible, setting the level of PEEP m ay be guided by m easurem ent of static pulmonary p ressure2vo lum e curve. U nless contraindicated, patients w ith A RD S should be m aintained sem i2recum benṫ P rone po sitioning should be considered in the patients w ith severest A RD S. Sedation p ro toco ls should be used. Paralysis is no t recomm ended. T he lim ited flu id m anagem en t strategy is beneficial fo r A RD S. Co rtico stero id is no t recomm ended fo r A RD S. T he ro le of o ther drugs is uncertain in A RD S. Conclusion Evidence2based recomm endations can be m ade regarding m any aspects of the acute m anagem ent of AL IgA RD S that w ill hopefully translate into imp roved outcom es fo r the critically ill patienṫ T he guidelines w ill be updated w hen som e impo rtant new know ledge becom es available. (AL I) g (A RD S) 18g10 13g10 23g10, 2005, AL IgA RD S 79g10, 59g10 AL IgA RD S, AL IgA RD S,, (A ID S) AL IgA RD S AL IgA RD S, :, AL IgA RD S :,,, ; :,, AL IgA RD S,,, 2001 ( ISF) D elph i ( 1),A RD S AL Ig 5 A E A RD S 25% 50% 40%,, A 11% 25% 9% 26% 2 3,AL IgA RD S 1 AL IgARD S,AL IgA RD S, AL IgA RD S h 76% 85% 93% A RD S g A RD S, A RD S 50% 15 ( ICU ) A RD S AL IgA RD S 6815% A RD S 1994 AL IgA RD S, AL I A RD S

2 707 2 AL IgARD S, AL IgA RD S, A RD S g, 2: AL IgA RD S A RD S (E ) (N IV ): N IV, (RCT ) N IV (CO PD ), N IV N IV AL IgA RD S N IV A RD S,A RD S, 2004, CO PD A RD S,,N IV, g, g ICU N IV AL IgA RD S N IV 54 AL Ig AL IgA RD S 1, A RD S, 70% N IV 5 7 d AL Ig A RD S, A RD S N IV RCT g,, N IV 14 d, AL IgA RD S,AL IgA RD S N IV 3 AL IgARD S A RD S,,AL IgA RD S :, N IV h ; Sevransky AL IgA RD S, ; h, ;, X N IV, N IV AL IgA RD S, (VA P ) ;, 2 RCT 1 AL IgA RD S 1994 : ; (PaO 2gF io 2) N IV mm H g 1 mm H g= kpa (PEEP) RCT,N IV ; X ; ICU ICU 18 mm H g 52 PaO 2gF io mm H g, AL I ( ) RCT 4 AL IgARD S, N IV 411 :, ICU AL IgA RD S % 50% AL IgA RD S,N IV (M OD S) AL IgA RD S N IV A RD S, AL IgA RD S N IV : ; ; AL IgA RD S ; 1: AL IgA RD S ; (E ) ; N IV 412 AL IgA RD S : AL IgA RD S N IV 1 2 h, (PaO 2) mm H g N IV ;, N IV 1 A 2 g g, B 1 g g,, g C g g D 1 g g E g g g

3 708 RCT 3: AL IgA RD S,A RD Snet, 4: AL IgA RD S, 5: N IV AL IgA RD S, AL IgA RD S,A RD S, 41213, A RD S : A RD S A RD S; A RD S A RD S, RCT A RD S, 8: A RD S, (E ), PEEP : A RD S 6: A RD S VAL I (E ) PEEP,, : A RD S,, VAL I PEEP 5 A RD S PEEP RCT A RD S PEEP A RD S,, Am ato A RD Snet PEEP> 12 cm H 2O > 16 cm H 2O A RD S, 3 - (P- V ) PEEP Am ato V illar,, 3, P - V + 2 cm H 2O PEEP,, P- V (VAL I) 5 RCT + 2 cm H 2O PEEP < 30 cm H 2O (1 cm H 2O = 9: PEEP, kpa) 2, P - V > 30 cm H 2O cm H 2O PEEP (C ) < 30 cm H 2O : (< > 33 cm H 2O ) A RD S, g, (P = 01002), ( m lgkg) ICU (P = 01180) (P < 01001),,A RD S 10: A RD S A RD S, (C ) (PaCO 2) : A RD S VA P, VA P VA P,, VA P 30 RCT, ( 45 ) VA P, 34% 8% (P = 01003), VA P, 23% 5% (P = 01018) ph > 7120 VA P 7: A RD S, VA P cm H 2O (B ) 11:, A RD S : A RD S (B ) PEEP : A RD S, PEEP 7 h, 7 d, PEEP A RD S (PCV ), PaO 2gF io 2, cm H 2O s PaO 2gF io 2< 88 mm H g,, g (SA PSg )

4 709, SA PSg 49,,AL IgA RD S 20 h RCT A RD Snet A RD S A RD S,, ( ), (- 136 m l m l), PaO 2gF io 2, ICU 12: A RD S,, (D ) AL IgA RD S : A RD S RCT, ICU, R am say A RD S, R am say 3 4 A RD S, RCT, A RD S, ICU 2 RCT, ( < ggl ) AL IgA RD S, A RD S A RD S, VA P, A RD S, A RD S, VA P 15:, 13: A RD S, AL IgA RD S ( ) (B ) (B ) 14: A RD S 16: A RD S, (E ), :, (C ) : AL IgA RD S, 72 h A RD S, 50% 90 AL Ig A RD S 3 RCT A RD S RCT,,, A RD S, A RD S, < 55 A RD S, AL IgA RD S,, A RD S, A RD S (ECM O ): A RD S, ECM O 46% 66% RCT A RD S RCT,, ECM O A RD S ECM O 1 A RD S ECM O net 413 AL IgA RD S A RD S ( 7 24 d), : AL IgA RD S ( 2 m g kg - 1 d - 1, 4 AL IgA RD S,,, 14 d ) 60 d, AL IgA RD S,A RD S > 14 d, A RD S AL IgA RD S 17:, VA P A RD S (B ) (NO ) : NO,

5 710 NO, IL - 8,,, g 2 TN F,NO (A felimom ab), 60% A RD S IL - 6 M ONA RCS (n= 2 634), IL - 6 NO h 2, A felimom ab RCT,NO A RD S NO A RD S AL IgA RD S, 18: NO A RD S A RD S (A ) (Pentoxifylline) (PS): A RD S PS (L isofylline): PS, TN F- Α IL - 1, IL - 6 PS A RD S, RCT RCT AL IgA RD S, PS,A RD S g (n= 235) ICU 30 d A RD S, 28 d ( PS 3119%, 2417%, P = 01215),, 28 d, PS 50 m ggkg 4, 100 m ggkg 4 8, A RD S 28 d A RD S (4318% 5010% 1818% 1616%, P = 01075) C (rha PC D ro trecogin alfa): 2 RCT, PS (24 rha PC, h) A RD S g, 24 Λg kg - 1 h - 1 A RD S PS rha PC 96 h g (A PA CH Eg ) > 25 A RD S, rha PC A RD S, rha PC A RD S g, A RD S rha PC A RD S,, A RD S A RD S,, E 1 (PGE1): PGE1, rha PC rha PC, : PGE1, PGE1 A 2 PGE1, A RD S A RD Snet AL IgA RD S RCT, (n= 234) A RD S PGE 1 PGE 1, ICU, PGE1 28 d PGE 1, RCT, AL IgA RD S A RD S PGE (P rocysteine) N : Ξ- 3 (NA C): NA C (DHA ) (EPA ), (GSH ), GSH, PGE 1 GSH,, A RD S EPA Χ- NA C AL I, IL - 8 A RD S g AL I,,NA C, EPA Χ- g g A RD S,, NA C A RD S EPA Χ-, : ICU, AL IgA RD S A 2 28 d, EPA Χ- ICU, AL IgA RD S A RD S, (A RD S EPA Χ-, 130 ) A RD S, 19: EPA Χ-, AL Ig A RD S 30 d A RD S (C ) AL IgA RD S ( ):,, :,,,,, AL IgA RD S : (Em ail: haiboq2000@yahoo. com. cn); (TN F) - 1 ( IL - 1) (Em ail: dw liu@m edm ail. com. cn dw liu@pum ch. cn)

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