급성 호흡곤란 증후군의 정의,원인,병태생리,치료에 대한 요약자료입니다.

소개

-difinition
-Etiology
-Pathophysiology
-Clinical presentation
-Diagnostics
-Medical management
-complication

목차

■ difinition
■ Etiology
■ Pathophysiology
■ Clinical presentation
■ Diagnostics
■ Medical management

본문내용

㉠ ABGA : refactory hypoxemia is key indicator
FiO2 증가에도 PaO2는 감소.
hyperventilation으로 pH가 증가 가능(>7.45), CO2 정상 또는 증가
ARDS 악화시 pH 감소하며 respiratory acidosis
anaerobic metabolism 보상으로 metabolic acidosis
㉡ Pulse oximetry : oxygenation 평가 위해 continuous monitoring
㉢ Mixed venous oxygen saturation(SvO2) : noraml(60~80%)
<50%의 경우 tissue oxygenation impaire
㉣ serial chest X-ray : 초기에는 normal
ARDS 진행시 bilateral diffuse infiltrate
후기에는 air space가 거의 없으며 Lt lung만 조금 남게 됨.
㉤ Pulmonary function test : static & dynamic compliance decresed.
lung vol. (FRC) decresed.
㉥ hemodynamic monitoring : PAWP normal in ARDS
high(>12mmHg) in cardiogenic pulmonoary edema
* PAWP is more sensitive indicator of fluid balance CVP
㉦ Tracheal-protein/plasma protein ratio
new diagnotic tool between cardiogenic & non-cardiogenic pul. edema(ARDS)
tracheal aspiration protein과 serum protein을 비교.
ratio <0.5 = cardiogenic pul. edema
>0.7 = generaly ARDS
㉧ Lactic acid level : hypoxemia로 인한 anaerobic metabolism을 평가
㉨ P(A-a) O2 : ARDS에서는 증가
alveolar flooding으로 인한 intrapulmonary shunting을 반영
㉩ QS/QT : normal physiologic shunt = 3-4%
ARDS = 15-20%

참고자료

· IMMUNOLOGY, Ivan Roitt 외 2, 1993, Mosby
· Common Variable Immunodeficiency, C Lucy Park, MD, 2004 May, e-Medicine