一位急性呼吸窘迫症病人在呼吸器策略及俯臥後併發氣胸之探討

急性呼吸窘迫症，近十年來，許多大型臨床研究發現，其主要呼吸治療策略趨勢，包括增加吐氣末陽壓、使用肺泡回復術及肺保護策略等呼吸器策略。另外，也包括非呼吸器策略，如吸一氧化氮、俯臥等治療，結果發現可以提升病人氧合狀態，但對於改善死亡率，仍然無很強的實證。本篇個案報告，探討一位急性呼吸窘迫症病人之呼吸治療策略，其經高氧及高吐氣末陽壓，氣道壓力釋放通氣模式，俯臥等呼吸治療策略，病人仍呈現頑固性低血氧，且在俯臥後併發氣胸，個案最終因嚴重缺氧及休克，而死亡。藉由此病例來探討，急性呼吸窘迫症病人呼吸器及非呼吸器之呼吸治療策略，在策略的方式，選用的時機，使用時間，適應症、併發症、病人最終死亡率等相關議題，以提供在加護病房急性呼吸窘迫症病人，使用最佳的呼吸治療策略之參考。（呼吸治療2012；11 （1） 11-24）

關鍵字

急性呼吸窘迫症；呼吸器策略；氣道壓力釋放通氣模式

並列摘要

The many large clinical study found that the main trends in treatment strategy in acute respiratory distress syndrome (ARDS) over the past decade, the ventilatory strategies included increase end-expiratory positive pressure(PEEP)、lung recruitment maneuver and lung protection. In the nonventilatory strategies, also included inhalation NO, prone position. The results showed that patients can improve oxygenation, but to improve the mortality rate, still no strong evidence. This case report discussed strategies of ventilation and non-ventilation form a patient with ARDS. This patient of respiratory treatment strategies were been high oxygen, high PEEP, airway pressure release ventilation mode, prone position, this patient was still refractory hypoxemia, and prone position cause pneumothorax complication, this patient eventually died of severe hypoxia and shock. Therefore, that investigated ventilatory and non-ventilatory strategies from patient with ARDS by this case report, in the way of strategy, the choice of timing, duration of use, indications, complications, patient mortality and other related issues the final, to provide respiratory treatment strategy of using the best reference from patients with ARDS in the intensive care unit.

並列關鍵字

Acute respiratory distress syndrome ； ventilatory strategy ； airway pressure release ventilation mode

國際替代計量

一位急性呼吸窘迫症病人在呼吸器策略及俯臥後併發氣胸之探討

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