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🌱 來自: acute respiratory distress syndrome

The 6 Ps-acute respiratory distress syndrome

PEEP titration methods (see below)

Proning:

• if PaO2/FiO2 <150, prone positioning ≥16 h ↓ mort ~50% (NEJM 2013;368:2159)

Paralysis:

• no benefit routinely (NEJM 2019;380:1997); consider if ventilator dyssynchrony

Peeing (fluid balance):

• target CVP 4–6 cm H2O (if nonoliguric & normotensive) → ↑ vent/ICU-free days, but no Δ mortality (NEJM 2006;354:2564); PA catheter unproven (NEJM 2006;354:2213); consider BNP >200 to trigger diuresis (UOP goal 4.5–9 mL/kg/h × 3 h)

Pulm vasodilators:

inhaled NO or prostacyclins ↑ PaO2/FiO2; no ↓ mort or vent-free days (BMJ 2007;334:779)

Perfusion (V-V ECMO):

may be useful if refractory (NEJM 2018;378:1965)