La Revue de medecine interne · 2002
[Main points in intensive care medicine].
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Brochard L
Аннотация
PURPOSE: Progresses in intensive care medicine have concerned major syndromes associated with life threatening organ dysfunction, like the acute respiratory distress syndrome (ARDS) or septic shock.
CURRENT KNOWLEDGE AND KEY POINTS: A better understanding of interactions between mechanical ventilation and the underlying lung lesions, has lead to define a so-called "lung protective ventilation", which resulted in an improved prognosis of ARDS. In numerous situations of acute respiratory failure, including acute exacerbation of chronic obstructive pulmonary disorder or immunosuppressed patients, endotracheal intubation can be avoided by the use of face mask ventilation, also called noninvasive ventilation. This approach results in a reduction of complications associated with mechanical ventilation or with the entire intensive care unit stay, including nosocomial infections. As a result, survival is increased when this kind of ventilation is feasible. In septic shock, pharmacological improvements have concerned effects of sepsis on coagulation, and the unexpectedly high frequency of relative adrenal insufficiency. Lastly, improvements have been made regarding the prevention and management of ventilator-associated pneumonia.
CURRENT KNOWLEDGE AND KEY POINTS: A better understanding of interactions between mechanical ventilation and the underlying lung lesions, has lead to define a so-called "lung protective ventilation", which resulted in an improved prognosis of ARDS. In numerous situations of acute respiratory failure, including acute exacerbation of chronic obstructive pulmonary disorder or immunosuppressed patients, endotracheal intubation can be avoided by the use of face mask ventilation, also called noninvasive ventilation. This approach results in a reduction of complications associated with mechanical ventilation or with the entire intensive care unit stay, including nosocomial infections. As a result, survival is increased when this kind of ventilation is feasible. In septic shock, pharmacological improvements have concerned effects of sepsis on coagulation, and the unexpectedly high frequency of relative adrenal insufficiency. Lastly, improvements have been made regarding the prevention and management of ventilator-associated pneumonia.