apest epea tp

1
??ap?e?st??? ??ep???e?a t?p?? ? ????e?µ?????
??s?µata st? ??T

• Gaßa?? ??e???d?a
• ??e?µ????????- ??tat????????
• ?p?µ. ?
• ?a?/?? ??T
• ??s???µe?? ???

2
?? e??a? ? a?ap????

• ??ta??a?? t?? ae???? ?2 ?a? CO2 µeta?? t??
  pe??ß?????t?? ?a? t?? ??tt???? t?? ?st??
• ??a????eta? se ?s? ?a? ??? a?ap???

3
??? a?ap???

• ??ta??a?? t?? ae???? µeta?? pe??ß?????t?? ?a?
  a?µat??
• S??e??as?a p????? ??????? a?ap?e?st???
  ???t??,?e??a, µ?e?, ???a???? t????µa, p?e?µ??e?,
  ?a?d??

4
?s? a?ap???

• ??ta??a?? ae???? µeta?? t?? a?µat?? ?a? t??
  ??tt???? t?? ?st??

5
??at???s? epa????? ?st???? ???????s??
??tta??
6
??ad??as?a t?? a?ap????

• ??e?µ?????? ae??sµ?? - ???µ?s? ae??sµ??
• ?????s? ae???? µeta?? ???e??d?? ?a? a?µat??
• ?etaf??? ???????? st??? ?st???

7
???µ?s? ae??sµ??
?? ?e????? s?st?µa ???µ??e? t?? ?at? ?ept?
ae??sµ? ?ts? ?ste ?? p??se?? t?? ???????? ?a?
t?? d???e?d??? st? a?µa ?a µetaß?????ta? e????sta
se ?p??esd?p?te s?????e?
8
PULMONARY VEINS
PULM ARTERIES
9
Alveolus
O2
RBC
CO2
Capillary
BLOOD
10
??ap?e?st??? ??ep???e?a

• ??? a?ap???
• ?d??aµ?a t?? a?ap?e?st???? s?st?µat?? ?a
  e?p????se? t? ?e?t?????a t?? a?ta??a??? t??
  ae???? ?at? t?? ??eµ?a ?a? ?at? t?? ?s??s?

• ?e? e??a? µ?a ??s??
• ?e?t??????? d?ata?a?? ap?t??? d?af???? ??s?µ?t???
  
• p?? ep?d???? st???
  p?e?µ??e? ? d?ata?a?? t?? a?ta??a??? t?? ae????

11
??t?a ??ap?e?st???? ??ep???e?a?

• ??s?µata p?? af????? t? a?ap?e?st??? ???t??
  (p??t?pa??? ???e??d???? ?p?ae??sµ??, ????
  ?a???t???? ?a? ??eµ?st???? ??s???, a?a?s??s?a,
  ???a????? ß??ße?)
• ??s?µata p?? e?att????? t? d??s? t?? st???e???
  p?? ?????? t? ???a?a (???a?t?as?, ?p??a??a?µ???
  a?????s?, s??????s? ?at? p???a?, µ?as???e?a,ß??ß?
  t?? ??t?a??? µ?e???, p????µ?e??t?da, as??t??,
  µe???? pa??sa???a, p?e???t?da ?.a.)
• ??s?µata t?? p?e?µ???? ?a? t?? ae??f???? ?d??
  (S??d??µ? a?ap?e?st???? d?s???e?a? t?? e???????,
  ate?e?tas?a, ß??????? ?s?µa, ?????a ß?????t?da,
  eµf?s?µa, p?e?µ???a, p?e?µ????? ??d?µa,
  p?e?µ????? eµß??? ?.a.)

12
??ap?e?st??? a?ep???e?a

• ??t??s? ae???? a?t???a??? a?µat??
• PaO2 lt 60 mmHg ?
• PaCO2 gt40-45 mmHg ? ?a? ta d??
• ??eta??µe???
• se ??eµ?a
• a?ap??e? atµ?sfa????? a??a (FiO2 21)
• ep?ped? ???assa?
• ??? e?d??a?d?a?? e?p???????a
• ??? µetaß????? a?????s?

13
?a????µ?s? ??ap?e?st???? ??ep???e?a?

• ?p??a?µ???? t?p?? (t?p?? ?)
• ?p??a?µ???? ?a? ?pe??ap????? t?p?? (t?p?? ??)
• ??e?a
• ?????a
• ??e?a ep? ?????a?

14
?p??a?µ???? t?p?? (t?p?? ?) ??ap?e?st???
a?ep???e?a

• ?????te? ß??ße? t?? p?e?µ????
• ??t?p?sµ??e? ß??ße? t?? p?e?µ????

• ?a??f?s????????? µ??a??sµ??
• s??s? ae??sµ??/a?µ?t?s??
• shunt
• d????s?

15
?p??a?µ???? t?p?? (t?p?? ?) ??ap?e?st???
a?ep???e?a

• H ?? t?p?? ? s???de?eta? ap?
• epa??? ae??sµ?
• ?
• ?pe?ae??sµ? t?? ???e??d??
• ? f?s???????? ? ? PaCO2

16
??ata?a??? V/Q

• ? V/Q V/Q
  ?V/Q

Dead space
Shunt
17
??? d?µ?????e?ta? ? ?p??a?µ?a st? p?e?µ?????
??d?µa?
18
?????s?
19
?pe??ap????? t?p?? (t?p?? ??) ??ap?e?st???
a?ep???e?a

• ?a??f?s????????? µ??a??sµ??
• ?p?ae??sµ??
• ? a???s? t?? PaCO2 s?µa??e? ???e??d??? ?p?ae??sµ?
• P?CO2 PaCO2?VCO2/VA
• VCO2 pa?a??µe?? p?s?t?ta CO2
• VA ???e??d???? ae??sµ??

20

• ? pa?a???? CO2
• ???et??
• ?????
• S???
• ??a?µa
• ?pe????e?e?d?sµ??
• ??a?ta ?dat????a?e?

• F?s????????
• ? ae??sµ?? ? a?????a
• µe t?? µetaß??????
• a????e? t??
• ???a??sµ??

21

• ?e???? ?????
• A?at?µ????
• ?e?t???????? ???e??de? p?? ae?????ta?, a??? de?
  a?µat????ta?

• V? ??????/min ae??sµ?? V? f
• VD ae??sµ?? ?e???? ?????/ min
• VA ???e??d????/min
• V? VA VDVA VE VD
• VD/V? 0,28-0,36 f.t

PaCO2?VCO2/VA VA VE VD PaCO2 ?VCO2/ (1-
VD/V?)V?f
22
??ap?e?st??? ????s? ?a? ?p??a?µ?a

• ? ???e??d???? ?p?ae??sµ?? e??a? a?t?? ?p??a?µ?a?
• ??t? ?fe??eta? st?? ep?d?as? t?? ? t??
• paCO2 ?a? ?atep??tas? t?? p?CO2, st??
• p?O2 ?a? st? s????e?a st?? paO2

• p?O2 FiO2(PB-PH2O)-PaCO2/RQ
• pAO2-paO2 ???e??d?a?t???a?? d?af???
• ???e??daatµ?sfa?????760mmHg
• ?d?atµ??, ???t? , ?2, C?2

23
?µ???? ?p?ae??sµ??

• ????e??d?a?t???a?? d?af??? e.f.?
• ....d?af??et???
• .... ?p???e? ?a?
• ????? µ??a??sµ?? ?pe?????? ??a t??
  ?p??a?µ?a, p?? s???de?e? t?? ?pe??ap??a

24
????? ? µ??a??sµ?? ??ap?e?st???? ??ep???e?a? st??
p?? ??t? ?atast?se?? ?

• ?te?e?tas?a
• ??e?µ???a
• ??s??f?s?
• ??e?µ????? ??d?µa
• ??e?µ????? eµß???
• ??e?µ????a?a?
• ?atast??? t?? a?ap?e?st???? ???t???

25

• ? V/Q V/Q
  ?V/Q

Dead space
Shunt
26
??ap?e?st??? ??ep???e?a Te?ape?a

• ??t????????
• ??t?µet?p?s? t?? ?p??e?µe??? a?t???
• ?p?st????t???
• ??at???s? t?? ???? µ???? ?a a?t?µet?p?ste? ? a?t?a

27
??ap?e?st??? ??ep???e?a ?p?st????t??? ?e?ape?a

• ?p?f??? a?t?µet?p?s? ep?p?????
• ?p? t? a?ap?e?st???, s???, DVT, stress ????,
  s?t?s?/????? ?.a.

• ??at???s? epa?????
• ?st???? ???????s??
• ??ap?e?st???, ?a?d?a??e?a??, ???p? ???a?a

• S???p?????ta ??s?µata

28
??ap?e?st??? ??ep???e?a ?p?st????t???
?e?ape?aa?ap?e?st????
?2

• ?pa??? ???????s?
• ?pa???? ae??sµ??
• ?p?f??? a?t?µet?p?s? ep?p?????
• ????????e?ape?a ???a????? ae??sµ??

??? ????
29
H ap?fas? d?as?????s?? e?sa????? se ??T

• p???p???te? ?t? ?p???e? µ???? ?st? p??a??t?ta
  ep?ß??s?? ?a? e??d?? t?? as?e????

SOS
30
??ap?e?st??a? p?e?µ????? ß??ß? (VILI)

• ?pe?d??tas? t?? p?e?µ?????? pa?e???µat??
• ??????? ep?st??te?s? s?µpt?s? ???e??d?? µe ???e
  a?ap???
• ????? FiO2

31
?p??a?µ???? t?p?? (t?p?? ?) ??ap?e?st???
a?ep???e?a

• ??e?µ????? ??d?µa
• ?a?d???e??? µ? ?a?d???e???

32
? d?????sa p?es? ?a?????eta? ap? t?? d?af???
µeta?? t?? e?da??e?a??? ?a? t?? e?a??e?a???
p??se??.
Osµ?t??? p?es? t????e?d??
?d??stat??? p?es? t????e?d??
Osµ?t??? p?es? pe??t????e?d???
S?? d?ape?at?t?ta a??e???
?d??stat??? p?es? pe??t????e?d???
??s?t?ta e?a??e???µe??? ????? ap? t????e?d? st??
d??µes? ????
S?? Osµ?t???? a????as??
?? d???µe?? t?? Starling st?? p?e?µ??a
33
?a?d???e??? ??e?µ????? ??d?µa

• ??t?µ?s? t?? p?es?? sta p?e?µ????? t????e?d?
• ??t??s? t?? p?es?? e?sf???s?? (?a?et???asµ?? t??
  p?e?µ?????? a?t???a?)
• PCWP gt 18 mmHg

• ????s? t?? p?es?? sta p?e?µ????? t????e?d?
• ? ???d?? ????? st? d??µes? ????
• ? st?? ???e??d??? ????

34
?a?d???e??? ??e?µ????? ??d?µa

• ?st?????
• ?a?d?a??? ??ep???e?a?
• ??t???a?? ?p??tas?
• Stefa??a?a ??s??
• ?a?ß?d?p??e?a

• ??????? e??tas?
• ???tas? ?a?d???
• ???tas? sfa??t?d??
• ?a?pasµ??, f?s?µata, a????µ?a
• ??????µ??? ?pa?
• ?e??fe???? ??d?µata

35
?a?d???e??? ??e?µ????? ??d?µa

• ?a?d?a??? ???µ??, ??, SaO2
• a???as? ???a?a

• a/a ???a?a
• ??T?
• ??a?ata??µ? t?? a?µ?t?s??
• ?p?tas? t?? p????
• ?e??a??e?a?? pe??ß??????? as?fe?a
• G?aµµ?? Kerley A B
• ?????te? s???se??- e????a fte??? peta???da? ?
  ???te??da?

36
?a?d???e??? ??e?µ????? ??d?µa

• ??????s?
• ?st?????
• ??????? e????a
• ????µata ?????- a?t?????????? e??????

• Te?ape?a
• ?e?t??s? s?sta?t???t?ta? t?? µ???a?d??? (???t??pa
  a?t?a????µ???)
• ?e??s? te??d?ast?????? p?es?? (a??e??d?asta?t???
  d?????t???)
• ??????s? ?2
• ???a????? ae??sµ??

37
?? ?a?d???e??? ??e?µ????? ??d?µa ARDS

• ?ernard et al 1994
• ???sµ?? - ???t???a
• ??e?a e?sß???
• ?µf?te??p?e??a d????µata st?? a?t?????af?a ???a?a
• PCWP lt 18 mmHg ? ap??s?a ?a?d?a??? a?t?a?
• ???apa?t??µe?? G??st?? p??d?a?es???? pa?????ta?
• PaO2 / FiO2 lt300 ALI ??e?a ß??ß? t?? p?e?µ??a
• PaO2 / FiO2 lt200 ARDS

38
??e?µ????? ARDS

• ?µes? p?e?µ????? ß??ß?
• S????? a?t?a
• ??e?µ???a
• ??s??f?s? ?ast????? pe??e??µ????

• ????te?? s????? a?t?a
• T??s? p?e?µ??a
• ??p?d?? eµß???
• ????µ??
• ??sp??? t?????? ??s??? (??e?d?a a??t??, aµµ???a,
  ???????, d???e?d?? t?? ?e???, ??dµ??, f?s???e??)
  ? ?ap???.
• ??d?µa ap? epa???de?s? (µetaµ?s?e?s?,
  eµß??e?t?µ?)

39
???-??e?µ????? ARDS

• ?µµes? p?e?µ????? ß??ß?
• S????? a?t?a
• S???
• ?a?? t?a?µa µe pa?atetaµ??? ?p?tas? ?a? / ?
  p???ap?? ?at??µata
• Shock
• ????ap??? µeta???se??

• ????te?? s????? a?t?a
• ?a?d??p?e?µ????? pa???aµ??
• Fa?µa?e?t??? a?t?a (p.?. ??????, sa????????,
  pa?a????t, ???a??f?sf????? ??p)
• ??e?a pa???eat?t?da
• ?et????s? p?????t?? a?µat??-?????t? e?da??e?a??
  p???
• Te?µ?p????a, ???a?µa
• ??aß?t??? ?et????s?
• ???aµ??a

40
???d?a?es???? pa?????te?-ARDS

• S??? 40-60
• ??a?µa 20-35
• ??s??f?s?/??s.p?e?µ???a 10-20
• ?????? µeta???se?? 9
• ?a???eat?t?da 7

41
ARDS a?ta??a?? ae????

• e?d????e??d??? e??d??µa
• ate?e?tas?e?
• pe?????? ???s??

• ?p??????a?µ?a
• Shunt
• ? V / Q
• ??ata?a?µ??? ?p????? p?e?µ????? a??e??s?spas?
• ???µ??ap??a/ ?p??ap??a
• a?????

• ?compliance
• ?a?t?st?se?? ????

42
ARDS ???d??µat??? f?s?
ARDS ???d??µat??? f?s? ?pe?p?ast??? f?s? F?s?
???s??
43
Te?ape?a st????
??t?µet?p?s? t?? ?p??e?µe??? a?t?a? ?a?d??-p?e?µ?
???? ?p?st????? ??d???? ?e?ape?e? ?at? t??
p?e?µ?????? ß??ß?? ?p?st????t??? a????
44
ARDS ?p?st????t??? ?e?ape?aa?ap?e?st????
?2

• ?pa??? ???????s?
• ?pa???? ae??sµ??
• ?p?f??? a?t?µet?p?s? ep?p?????

??? ????
45
ARDS ??de??e?? d?as?????s?? µ??a????? ae??sµ??

• ??e?a ?p??a?µ??? a?ap?e?st??? a?ep???e?a
• ta??p???a
• ??e?a a?ap?e?st??? d?s???e?a ?a?
• ep?µ??? ?p??a?µ?a pa?? t?? ??????s? ?????? FiO2
• ? se pa???s?a ?p????d?p?te ap? ta pa?a??t?
• ??e?a ?a?d?a??e?a?? ast??e?a
• d?ata?a?µ??? ep?ped? s??e?d?s?? ? ???e???
  s??e??as?a?
• ad??aµ?a p??stas?a? t?? ?at?te??? ae?a?????

46
ARDS ???a????? ae??sµ?? ???stas?a t?? p?e?µ????

• ? Vt
• ????
• ap?f??? ?pe?d??tas??

47
ARDS ????

• ?FRC
• (ep?st??te?s?ate?e?tas???? ???e??d??)
• ????????s? (a?????a µe t?? ???? t?? p?e?µ??a p??
  ep?st?ate?eta?)
• eµp?d??e?
• t? ??????? ?????µa/??e?s?µ?
• t?? ???e??d??

48
ARDS PEEP
49
(No Transcript)
50
PEEP

• ?pe?ß????? ????? ????
• ?pe?d?atas? ???e??d?? µe f?s???????? ae??sµ?
  ???d???? ßa??t?a?µat??
• ? ?e??? ????
• ??a?d?a?? pa????
• ? e?d??????a? p?es??
• a??e?t??? a?ap?e?st??? ????s?
• a?a??p?

51
?p?f?a?t???? t?p?? ??s?µata t?? p?e?µ????

• ???????? ?s?µa Status asthmaticus
• ?????a ?p?f?a?t??? ??e?µ???p??e?a (???)

52
???????? ?s?µa

• ep?pt?s? t?? ?s?µat?? ?pa???sµ???
• ?????a f?e?µ???d?? ??s?? µe epa?e???µµ??a ???a
  ap?f?a?t??? epe?s?d?a

53
pa??f?s??????a pa?????es?

• ap?f?a?? t?? ae?a?????
• s?spas? t?? ?e??? µ???? ???? t?? ß??????
• f?e?µ??? ??d?µa t?? ß???????? ß?e????????
• ß?sµata st??? ß??????? ap? e????se?? ?a?
  f?e?µ???d? p?????ta

54
pa??f?s??????a pa?????es?

• a?ap?e?st??? a?ep???e?a st? ?s?µa
• d?ata?a?? ae??sµ??-a?µ?t?s??
• ??p?s? t?? a?ap?e?st???? µ???

55
Status asthmaticus

• pa?atetaµ??? ?s?µat??? pa?????s? µe ta?e?a
  ep?de???s?, a??? µp??e? ?a eµfa??ste? ?? a?f??d?a
  ?a? s?ßa?? ap?f?a??
• µe??µ??? a?tap????s? st? ?e?ape?a µe
  ß-ad?e?e??????? a????st??
• ?pe??ap???? ??
• ??p?s? t?? a?ap?e?st???? µ???

56
Te?ape?t??? a?t?µet?p?s?

• ß?????d?asta?t???
• ???t???ste??e?d?
• ???????
• µ??a???? ?p?st????? t?? a?ap????
• s??p?? ?p?st????? t?? a?ap?e?st???? ?e?t?????a?
  µ???? ?a ?p?????se? ? ap?f?a?? t?? ae?a?????

57
?,t? sf????e? de? e??a? ?s?µa

• s?µf???t??? ?a?d?a?? a?ep???e?a
• ap?f?a?? a??te??? ae?a????? (p.? ?st?????
  d?as?????s??)
• pa?????s? ???
• a?t?µat?? p?e?µ????a?a?
• a?af??a??a
• ??e?a p?e?µ????? eµß???
• e?s??f?s? ????? s?µat??

58
ß??????? ?s?µa

• ??sa???? st? ??T
• 10 t?? ??s??e??µe??? as?e???
• ??as?????s?
• 2 t?? ??s??e??µe??? as?e???

59
??de??e?? µ??a????? ae??sµ??

• ep??easµ??? ep?ped? s??e?d?s??
• ??e?a ?pe??ap??a
• ??p?s? a?ap?e?st???? µ???
• ft??? a?tap????s? st? ?e?ape?a
• pa???s?a st???e??? ep??e?µe??? ??p?s?? t??
  e?sp?e?st???? µ???

60
ßas???? st????

• a??ta?? t?? ??
• a??pa?s? t?? a?ap?e?st???? µ???
• µe??s? t?? ????? t?? a?ap????
• ???d?? ??????
• ap?f??? ep?p?????

• ??at???s? epa????? ?st???? ???????s??

61
???????? ?s?µa p?te ???d??e?e? ? ??? t?? as?e???
SOS

• µ? a?a?????s? t?? ßa??t?ta?
• µ? a?a?????s? t?? ?a??ste??µ???? a?tap????s??
  st?? a????
• ?a??st???s? /ta?a?p???µ???? as?e???
• µ? ???a??? a?t?µet?p?s? ?pe?d??tas?? ? µ?
  ?ata???s? t?? s?µas?a? t?? ?? a?t?a? d?ata?a???
  t?? ae???? a?µat??

62

• ? p?? s???? a?t?a ?a??t?? st? ??T
• t?? as?e??? µe ß??????? ?s?µa
• e??a?
• ? pa??de?s? t?? a??a

63
?a??de?s? a??a-?pe?d??tas?

• ??? p????pte? sta ap?f?a?t??? ??s?µata t??
  p?e?µ?????
• ?e?p?e?st??? a?t?stas? ? ??????? ??a p???? e?p???
  
• ?a?ap?. ?s? ? ta??p???a ?a? ?d?a??s?µ?? ??????
  ??a e?p???
• a?at?????? ?at???? pa??µßas? st? µ??a???? ae??sµ?
  ??a t? d?????s? t?? ?pe??ap??a?

64
???aµ??? ?pe?d??tas? ??ep???e?a epa?af???? t??
p?e?µ??a st?? ???? ??eµ?a? st? t???? t?? e?p????
65
G?at? e????e? ? ?pe?d??tas??

• a????e? t? d??µet?? t?? ae?a?????
• ße?t???e? t?? e?p?e?st??? ??? ???? t?? a???s??
  t?? d??aµ?? e?ast???? epa?af????
  .........ep?µ???? ??at? e????e??

• ?p?p????? ?pe?d??tas??
• ßa??t?a?µa
• a?t???a?? ?p?tas?
• ??a?d?a??? pa?????
• a??e?t??? a?ap?e?st??? ????s?
• a?a??p? !!

66
e?t?µ?s? t?? pa??de?s?? a??a

• µ?t??s? t?? ?????? e?p?e?µe??? ?????VEI
• -?p???a 20-60sec- pa????t?? as?e???

• VEI gt 20 ml/kg p?????st???? de??t?? ??a
  ßa??t?a?µa ?p?tas?

67
e?t?µ?s? t?? pa??de?s?? a??a

• µ?t??s? t?? p?es?? st? t???? t?? e?p????
  (e?d??e??? ????)
• pa????t?? as?e???

68
µ?t??s? t?? te??-e?sp?e?st???? p?es?? (Pplat)
69
(No Transcript)
70
??t?a ??a t?? ap?f??? t?? d??aµ???? ?pe?d??tas??
st?? epeµßat??? µ??a???? ae??sµ?

• ? e?sp?e?st??? ??? (80-100L/min)
• ? e?p?e?st???? ?????? (IE13)
• ? f (p.?. a????? 11-14/min)
• ?Vt (5-8ml/kg)
• ???? 0-5 cmH2O
• e?e???µe??? ?p?ae??sµ?? (pH7.25) µ?t?a
  ?pa?a????? CO2-?atast???/µ?????as?
• Pplat lt 30 cmH2O

71
COPD???
72

• ?????a f?e?µ???d?? a?t?d?as?
• ?e?t??????
• pe??fe?????? ae?a??????
• p?e?µ????? pa?????µa

73
Pathogenesis of COPD
NOXIOUS AGENT(tobacco smoke, pollutants,
occupational agent)
COPD



Genetic factors Respiratory infection Other





74
Diagnosis of COPD
EXPOSURE TO RISK FACTORS
SYMPTOMS
cough
tobacco
sputum
occupation
dyspnea
indoor/outdoor pollution
è
SPIROMETRY
75
Spirometry Normal COPD
76
Post-bronchodilatorFEV1( predicted)
Management based on GOLD
77
pa?????se?? COPD

• p?? s????e?? a?t?e?
• ???µ??e?? t?? t?a?e??ß???????? d??d??? ?
  µ????s? t?? atµ?sfa??a?
• 1/3 t?? s?ßa??? pa?????se??
• µ? a?a?????s?µ? a?t?a

78
COPD Exacerbation
Pathophysiology - Current Hypothesis
Viral Infection 25
Unknown 20
Bacterial Infection 50
Air Pollution 5
79
Disease Trajectory of a Patients with COPD
80
pa?????se?? COPD a?t?µet?p?s? st? ???

• ??e???µe?? ????????e?ape?a
• ??????d?asta?t???
• S??d?asµ?? ß2 a????st?? a?t??????e?????
• ??s?µet????? s?s?e??? µe ae?????aµ? ?
  ?efe??p???t??
• ???s???? aµ???f???????
• ???s???? ???t???ste??e?d?? peros ? iv
• ???s???? a?t?ß??s?? peros ? iv, ep? e?de??e??
• ?? ?peµßat???? ???a????? ?e??sµ?? (?????
  d?as?????s?)

81
pa?????se?? COPD e?de??e?? e?sa????? st? ??T

• s?ßa?? d?sp???a d???? a?tap????s?
• s????s?, ???a????, ??µa
• a??e?t??? ? ep?de????µe?? ?p??????a?µ?a
  (PaO2lt40mmHg) ?/ ?a? ?pe??ap??a (PaCO2gt60mmHg) ?/
  ?a? ????s? (pHlt7,25)
• pa?? t? ??????s? ?2 ?a? ????

82
H ap?fas? d?as?????s??, ??? e?sa????? se ??T

• p???p???te? ?t? ?p???e? µ???? ?st? p??a??t?ta
  ep?ß??s?? ?a? e??d?? t?? as?e????

SOS ?????a, stad?a?? e?e??ss?µe?? ??s??
83
??t?a ??a t?? pe?????sµ? t?? d??aµ????
?pe?d??tas?? t?? e?d??e???? PEEP ?at? t?
???a???? ?p?st????? t?? ??ap????
SOS
84
?peµßat???? µ??a????? ae??sµ??

• p??? ep??et??? pa??µßas?
• ??p?te s?t???a ??a t? ???,
• a??? e???te? t?? as?e?? se p????? ep?p?????...