Objective Guide Individualized Ventilation Strategies In Acute Respiratory Distress Syndrome, Mechanical Ventilation

BackgroundInjurious ventilation can cause severe lung injury and subsequent systemic inflammatory reaction syndrome(SIRS), and affect outcome of patients in acute respiratory distress syndrome(ARDS). Ventilation strategy with lower tidal volumes was found to be protective for the lung and improve outcome of ARDS patients, contrasted with larger tidal volume. However, several limitations are found in lower-tidal-volume(LTV) strategy now, such as hypoventilation, arbitrary management of ventilation variables, how to manipulate open-lung therapy. In theory, the best ventilation strategy should combine LTV strategy with open-lung therapy, and set the ventilation variable based on real-time monitoring individual respiratory mechanism.People have made great progress on static pressure-volume(P-V) curve of respiratory system, which reflect individual respiratory mechanism. Individualized ventilation based on dynamic monitoring the above curve is an important trial for future exploring the new ventilation procedure after LTV strategy in ARDS patients. Objectives1. exploring best ventilation strategies to protect lung function and improve outcome,2. monitor the static P-V curve, and assess the characteristics during alveolar recruitment and derecruiment,3. clinical management goal-directed individual ventilation4. evaluate the ventilator induced lung injury with biomarker Methods1. Dynamic CT scan to monitor the intrapulmonary gas pressure, volume and distribution during alveolar recruitment and derecruitment gradually in 10 warm-saline-lavage New Zealand rabbits. In order to reflect the features of alveolar recruitment and derecruitment, we measured the static P-V curve and arterial oxygenation after sustained inflation.2. 30 ARDS patients who received invasive ventilation were randomly allocated into...