315 Ch 314. Acute Respiratory Distress Syndrome (ARDS) and Respiratory Failure

Respiratory failure 分 type I (hypoxemic, PaO2 < 60) + type II (hypercapnic, PaCO2 > 45) + mixed；ARDS = acute diffuse lung injury 造成的 type I hypoxemic respiratory failure；Berlin Definition 2012：onset within 1 week、bilateral opacities、not solely cardiac、PaO2/FiO2 < 300 with PEEP ≥ 5；severity = mild (200-300)、moderate (100-200)、severe (≤ 100)；common causes：pneumonia、sepsis、aspiration、trauma、transfusion (TRALI)、pancreatitis、burn、drug；lung-protective ventilation (ARMA, ARDSnet 2000) = tidal volume 6 mL/kg PBW + plateau pressure < 30 = 死亡率降；PROSEVA 2013 prone positioning ↓ mortality 16% in severe ARDS；ACURASYS neuromuscular blockade in severe ARDS (mixed results - ROSE neg)；ECMO for refractory (EOLIA + CESAR)；driving pressure (Plateau - PEEP) < 15 cm H2O strongly correlates with survival；conservative fluid management (FACTT) improves outcomes；ARDS subphenotypes：hyperinflammatory vs hypoinflammatory；2020-2024 COVID-19 ARDS lessons：early high PEEP + prone + dexamethasone (RECOVERY) + tocilizumab (REMAP-CAP) — game-changers。