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Pulmonary edema caused by pulmonary edema, damage to the lungs and "volumatal injury" (volume trauma)

Art., depending on the type of animal.
Transcapillary mechanical forces of comparable magnitude can occur when large respiratory volumes and peak static inspiratory pressure are used in the treatment of a disease involving inhomogeneous lung damage.
High values ​​of vascular pressure and blood flow can also be important evidence of lung damage.
MANAGEMENT OF PATIENTS
At present, there is no detailed clinical information on safe values ​​of maximum peak and average alveolar pressure, which can be used for a long time without damaging the alveoli or delaying the healing of the lung.
It is clear that the recommendations should be individualized (see Table 8.4).
Alveolar volumes and stresses in the areas of the damaged lung are undoubtedly different (see Fig.8.6).
The impact of the total pressure applied to the endotracheal tube should be evaluated according to the distensibility and vulnerability of each part of the lung.
Although the experiment showed that the retention of some minimal transalveolar pressure at the end of exhalation enhances the pre-existing damage to the alveoli, this phenomenon has not yet been demonstrated on the human body.
TABLE 8.5
CONTRAINDICATIONS TO ALLOWED HYPROCHEMISTRY
Increased intracranial pressure
Severe cardiovascular disorders
Severe pulmonary hypertension
Deep metabolic acidosis
Then everyone agrees with the conclusion that as soon as disclosure of the alveoli is reached, a further increase in the peep is probably useless or even harmful.
Thus, experts disagree on what is considered the optimal treatment during the first few days of the disease: applying the lowest value of PEEP capable of providing adequate gas exchange, or creating some minimum alveolar pressure at the end of expiration.
Some well-informed researchers continue to protect the occasional use of high-pressure injection to involve unstable areas of the lungs in ventilation, in particular when small tidal volumes are used (less than 4-5 ml / kg) or when HF ALV is used.
Peep waves should be eliminated during the course of the disease, especially if it is not possible to identify a bend area on the volume-pressure curve of the respiratory system.
Since the extensibility depends on the tidal volume, the choice of the appropriate VT depends on the level of peep and vice versa.
There is no general opinion about the effect of vascular pressure, changes in the patient's position, infection, oxygen concentration in the inhaled gas and other clinical variables on the frequency or intensity of lung damage caused by mechanical ventilation.
Raising PaCO2 to a level that exceeds normal (tolerable hypercapnia) seems to be an effective strategy for limiting inspiratory pressure (see Chapter 24, “Oxygenation Insufficiency”).
The full effect of hypercapnia on such important indicators as gas exchange, hemodynamics and tissue edema remains to be determined in those two situations in which this strategy is usually used - in asthma and ARDS.
In addition, for the use of this technique, there are relative and absolute contraindications (Table 8.5).
To achieve an almost complete saturation of arterial blood with oxygen, an increased FiO2 value and high inspiratory pressure in the airways are often required.
The conditions (if they exist), under which, without serious clinical consequences, it is possible to prevent the reduction of O2 arterial saturation to less than normal, have not yet been established.
There is no single clear opinion on the regional or general adequacy or inadequacy (desoxia) of O2 delivery, which is most suitable for everyday clinical use.
Such combinations of O2 concentrations and duration of their use, which cause substantial damage to the lungs, have not been firmly established for ARDS and may vary depending on the severity of the condition and individual sensitivity to hypoxia.
Similarly, there is still no detailed information regarding inspiratory pressure and infusion rate, which are safe for long-term use, although numerous experimental data have been accumulated.
In the absence of reliable data commissioned in a clinical setting, some experienced clinicians increase lung volume, trying to minimize FiO2, while others prefer not to increase peak and average pressure and peep pressure in the airways, but to use higher respirable O2 concentrations.
At level F, O2 is below 0.7, limiting Paw to a “safe” level is usually more important than limiting FiO2.
It has not yet been precisely established whether different methods of obtaining the same average pressure in the airways (such as PEEP and ventilation with an inverted inspiratory and expiratory ratio) differ in risk and benefits.
The extent to which independent ventilation has advantages over controlled ventilation is also not yet clear. (The treatment of ARDS is discussed in detail in Chapter 24, "Disorders of oxygenation.")
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Pulmonary edema caused by pulmonary edema, damage to the lungs and "volumatal injury" (volume trauma)

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