Acute respiratory distress syndrome (ARDS)
小结
定义
病史和体格检查
关键诊断因素
- low oxygen saturation
- acute respiratory failure
其他诊断因素
- critically ill patient
- dyspnea
- increased respiratory rate
- pulmonary crepitations
- low lung compliance
- fever, cough, pleuritic chest pain
- frothy sputum
危险因素
- sepsis
- aspiration
- pneumonia
- severe trauma
- blood transfusions
- lung transplantation
- pancreatitis
- history of alcohol misuse
- burns and smoke inhalation
- drowning
- e-cigarette and vaping product use
- Immunotherapy
- drug overdose
- cigarette smoking
诊断性检查
首要检查
- chest x-ray
- arterial blood gases
- sputum culture
- blood culture
- urine culture
- amylase and lipase
需考虑的检查
- brain natriuretic peptide (BNP)
- echocardiogram
- pulmonary artery catheterization
- bronchoalveolar lavage or endotracheal aspirate
- CT scan of the thorax
- Lung ultrasound
- viral testing
- open lung biopsy
治疗流程
all patients
撰稿人
作者
Lorraine B. Ware, MD
Ralph and Lulu Owen Professor of Medicine
Professor of Pathology, Microbiology and Immunology
Director
Vanderbilt Medical Scholars Program
Division of Allergy, Pulmonary and Critical Care Medicine
Department of Medicine
Vanderbilt University School of Medicine
Nashville
TN
利益声明
LBW has received consulting fees from Arrowhead, Akebia, Santhera, and Global Blood Therapeutics, all unrelated to the topic of this article. LBW has received research funding (to her institution) from the US National Institutes of Health, Boerhinger Ingelheim, and Genetech Inc., unrelated to the topic of this article. LBW holds stock in Virtuoso Surgical, unrelated to the topic of this article.
鸣谢
Dr Lorraine Ware would like to gratefully acknowledge Dr Richard Fremont, a previous contributor to this topic.
利益声明
RF declares that he has no competing interests.
同行评议者
Michael A. Matthay, MD
Director of Medicine Critical Care Fellowship
Department of Anesthesia and Perioperative Care
University of California San Francisco
CA
利益声明
MAM declares that he has no competing interests.
Timothy Evans, MBBS
Professor of Intensive Care Medicine
Royal Brompton Hospital
London
UK
利益声明
TE declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Matthay MA, Arabi Y, Arroliga AC, et al. A new global definition of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2024 Jan 1;209(1):37-47.全文 摘要
Bos LDJ, Ware LB. Acute respiratory distress syndrome: causes, pathophysiology, and phenotypes. Lancet. 2022 Oct 1;400(10358):1145-56.全文 摘要
Janz DR, Ware LB. Approach to the patient with the acute respiratory distress syndrome. Clin Chest Med. 2014 Dec;35(4):685-96.全文 摘要
Qadir N, Sahetya S, Munshi L, et al. An update on management of adult patients with acute respiratory distress syndrome: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2024 Jan 1;209(1):24-36.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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