{"id":34443,"date":"2022-10-28T17:56:12","date_gmt":"2022-10-28T10:56:12","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=34443"},"modified":"2022-10-28T18:12:13","modified_gmt":"2022-10-28T11:12:13","slug":"hoi-chung-suy-ho-hap-cap-2022-chan-doan-ket-cuc-va-dieu-tri","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/hoi-chung-suy-ho-hap-cap-2022-chan-doan-ket-cuc-va-dieu-tri\/","title":{"rendered":"H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p 2022 : Ch\u1ea9n \u0111o\u00e1n, k\u1ebft c\u1ee5c v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<p style=\"text-align: right;\"><a href=\"https:\/\/www.vnras.com\/drug\/\">nhathuocluuanh<\/a>. <a href=\"https:\/\/www.vnras.com\/drug\/2022\/10\/hoi-chung-suy-ho-hap-cap-2022-chan-doan-ket-cuc-va-dieu-tri.html\">H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p (ARDS) 2022<\/a><\/p>\n<p style=\"text-align: right;\">\u0110\u1ec3 t\u1ea3i file PDF, h\u00e3y click <a href=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Dich-Hoi-chung-suy-ho-hap-cap-2022-chan-doan-dieu-tri-ket-cuc-vnras.com\/drug_.pdf\">T\u1ea0I \u0110\u00c2Y<\/a>.<\/p>\n<p style=\"text-align: right;\">H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh: ch\u1ea9n \u0111o\u00e1n, k\u1ebft c\u1ee5c, di ch\u1ee9ng l\u00e2u d\u00e0i v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/p>\n<p style=\"text-align: right;\">Ellen A Gorman, Cecilia M O\u2019Kane, Daniel F McAuley<\/p>\n<p style=\"text-align: right;\">D\u1ecbch: B\u00e1c s\u0129.Hu\u1ef3nh Ph\u1ea1m Ho\u00e0ng Nam<\/p>\n<p><strong>H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p<\/strong> (ARDS) c\u00f3 \u0111\u1eb7c tr\u01b0ng l\u00e0 suy h\u00f4 h\u1ea5p gi\u1ea3m oxy m\u00e1u c\u1ea5p t\u00ednh v\u00e0 h\u00ecnh \u1ea3nh th\u00e2m nhi\u1ec5m 2 ph\u1ebf tr\u01b0\u1eddng tr\u00ean phim ph\u1ed5i, m\u00e0 kh\u00f4ng th\u1ec3 gi\u1ea3i t\u00edch \u0111\u1ea7y \u0111\u1ee7 do suy tim hay qu\u00e1 t\u1ea3i d\u1ecbch. ARDS \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a theo ti\u00eau chu\u1ea9n Berlin. Trong t\u1eadp san n\u00e0y s\u1ebd th\u1ea3o lu\u1eadn v\u1ec1 ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb, k\u1ebft c\u1ee5c v\u00e0 di ch\u1ee9ng l\u00e2u d\u00e0i. C\u00e1c h\u1ea1n ch\u1ebf ti\u1ec1m n\u0103ng c\u1ee7a \u0111\u1ecbnh ngh\u0129a ARDS v\u00e0 b\u1eb1ng ch\u1ee9ng cung c\u1ea5p th\u00eam trong t\u01b0\u01a1ng lai s\u1ebd \u0111\u01b0\u1ee3c xem x\u00e9t. H\u01b0\u1edbng d\u1eabn c\u00e1c khuy\u1ebfn c\u00e1o, ch\u1ee9ng c\u1ee9 v\u00e0 s\u1ef1 kh\u00f4ng ch\u1eafc ch\u1eafn li\u00ean quan \u0111i\u1ec1u tr\u1ecb ARDS c\u0169ng \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn. T\u01b0\u01a1ng lai c\u1ee7a ARDS l\u00e0 c\u1ed1 g\u1eafng h\u01b0\u1edbng \u0111\u1ebfn m\u1ed9t c\u00e1ch ti\u1ebfp c\u1eadn ch\u00ednh x\u00e1c v\u00e0 t\u00ecm ra khung \u0111i\u1ec1u tr\u1ecb trong ch\u1ea9n \u0111o\u00e1n v\u00e0 qu\u1ea3n l\u00fd ARDS.<\/p>\n<h2>Gi\u1edbi thi\u1ec7u<\/h2>\n<p><strong>H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p<\/strong> (ARDS) \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi <strong>suy h\u00f4 h\u1ea5p<\/strong> gi\u1ea3m oxy m\u00e1u v\u00e0 h\u00ecnh \u1ea3nh th\u00e2m nhi\u1ec5m 2 ph\u1ebf tr\u01b0\u1eddng tr\u00ean phim ph\u1ed5i, m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch \u0111\u1ea7y \u0111\u1ee7 b\u1eb1ng suy tim hay qu\u00e1 t\u1ea3i d\u1ecbch. C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 d\u1ec5 m\u1eafc ph\u1ea3i th\u00fac \u0111\u1ea9y ARDS l\u00e0 vi\u00eam ph\u1ed5i, nhi\u1ec5m tr\u00f9ng huy\u1ebft ngo\u00e0i ph\u1ed5i, h\u00fat d\u1ecbch d\u1ea1 d\u00e0y, ch\u1ea5n th\u01b0\u01a1ng, vi\u00eam t\u1ee5y, b\u1ecfng, t\u1ed5n th\u01b0\u01a1ng do h\u00edt s\u1eb7c, qu\u00e1 li\u1ec1u thu\u1ed1c, truy\u1ec1n m\u00e1u nhi\u1ec1u l\u1ea7n ho\u1eb7c s\u1ed1c. H\u1eadu qu\u1ea3 c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 n\u00e0y g\u00e2y ra m\u1ed9t lo\u1ea1t r\u1ed1i lo\u1ea1n \u0111\u00e1p \u1ee9ng vi\u00eam v\u00e0 ho\u1ea1t h\u00f3a cytokine. T\u1ed5n th\u01b0\u01a1ng h\u00e0ng r\u00e0o bi\u1ec3u m\u00f4 &#8211; n\u1ed9i m\u00f4 ph\u1ebf nang c\u00f3 th\u1ec3 x\u1ea3y ra tr\u1ef1c ti\u1ebfp do t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i, v\u1edbi t\u1ed5n th\u01b0\u01a1ng nguy\u00ean ph\u00e1t bi\u1ec3u m\u00f4 ph\u1ed5i, ho\u1eb7c gi\u00e1n ti\u1ebfp do nguy\u00ean nh\u00e2n ngo\u00e0i ph\u1ed5i, v\u1edbi t\u1ed5n th\u01b0\u01a1ng nguy\u00ean ph\u00e1t n\u1ed9i m\u00f4 m\u1ea1ch m\u00e1u l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a vi\u00eam to\u00e0n th\u00e2n. Tuy nhi\u00ean \u0111\u00e1ng ch\u00fa \u00fd l\u00e0 h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n ARDS \u0111\u1ec1u c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i c\u1ea3 tr\u1ef1c ti\u1ebfp v\u00e0 gi\u00e1n ti\u1ebfp. K\u1ebft qu\u1ea3 l\u00e0m ph\u00e1 v\u1ee1 h\u00e0ng r\u00e0o bi\u1ec3u m\u00f4 &#8211; n\u1ed9i m\u00f4 ph\u1ebf nang d\u1eabn \u0111\u1ebfn t\u00edch t\u1ee5 g\u00e2y ph\u00f9 ph\u1ed5i gi\u00e0u protein, suy ch\u1ee9c n\u0103ng surfactant v\u00e0 suy gi\u1ea3m trao \u0111\u1ed5i kh\u00ed. ARDS c\u00f3 th\u1ec3 li\u00ean quan r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng sinh l\u00fd nh\u01b0 gi\u1ea3m gi\u00e3n n\u1ee1 h\u1ec7 h\u00f4 h\u1ea5p, t\u0103ng kho\u1ea3ng ch\u1ebft sinh l\u00fd v\u00e0 t\u0103ng lu\u1ed3ng th\u00f4ng (shunt), c\u00f9ng v\u1edbi c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m m\u00f4 h\u1ecdc c\u1ee7a ph\u00f9 ph\u1ed5i, vi\u00eam ph\u1ed5i, b\u1ec7nh m\u00e0ng trong v\u00e0 xu\u1ea5t huy\u1ebft ph\u1ebf nang. V\u1ec1 kinh \u0111i\u1ec3n, d\u1ea5u hi\u1ec7u m\u00f4 h\u1ecdc ARDS \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u00e0 t\u1ed5n th\u01b0\u01a1ng ph\u1ebf nang lan t\u1ecfa, tuy nhi\u00ean, trong d\u1eef li\u1ec7u kh\u00e1m nghi\u1ec7m t\u1eed thi \u0111\u00e3 b\u00e1o c\u00e1o th\u00ec t\u1ed5n th\u01b0\u01a1ng ph\u1ebf nang lan t\u1ecfa ch\u1ec9 xu\u1ea5t hi\u1ec7n &lt;1\/2 b\u1ec7nh nh\u00e2n ARDS.<\/p>\n<p>Trong b\u00e0i n\u00e0y ch\u00fang ta s\u1ebd th\u1ea3o lu\u1eadn v\u1ec1 ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb, k\u1ebft c\u1ee5c v\u00e0 di ch\u1ee9ng l\u00e2u d\u00e0i c\u1ee7a ARDS. V\u00ec ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n nguy k\u1ecbch m\u1eafc COVID19 n\u1eb7ng c\u00f3 kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng \u0111\u1ea7y \u0111\u1ee7 ti\u00eau chu\u1ea9n ARDS, b\u1eb1ng ch\u1ee9ng li\u00ean quan COVID19 \u0111\u01b0\u1ee3c xem x\u00e9t trong su\u1ed1t b\u00e0i n\u00e0y. B\u1ea3ng 1 m\u00f4 t\u1ea3 hi\u1ec3u bi\u1ebft hi\u1ec7n nay c\u1ee7a ch\u00fang t\u00f4i v\u1ec1 c\u00e1c \u0111i\u1ec3m gi\u1ed1ng v\u00e0 kh\u00e1c nhau gi\u1eefa ARDS do COVID19 v\u00e0 ARDS do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c.<\/p>\n<h2>Ch\u1ea9n \u0111o\u00e1n<\/h2>\n<p>S\u1ef1 h\u1eefu \u00edch c\u1ee7a c\u00e1c c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n trong ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe l\u00e0 kh\u1ea3 n\u0103ng cung c\u1ea5p th\u00f4ng tin \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh l\u00e2m s\u00e0ng v\u00e0 x\u00e1c \u0111\u1ecbnh qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n c\u00f3 chung \u0111\u1eb7c \u0111i\u1ec3m, k\u1ebft c\u1ee5c v\u00e0 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb. ARDS l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng, di\u1ec5n ti\u1ebfn qua nhi\u1ec1u s\u1ef1 l\u1eb7p \u0111i l\u1eb7p l\u1ea1i ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n k\u1ec3 t\u1eeb khi Ashbaugh v\u00e0 c\u00e1c \u0111\u1ed3ng nghi\u1ec7p l\u1ea7n \u0111\u1ea7u m\u00f4 t\u1ea3 v\u00e0o n\u0103m 1967. Kh\u00f4ng th\u1ed1ng nh\u1ea5t v\u1ec1 ti\u00eau chu\u1ea9n ARDS cho \u0111\u1ebfn khi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a Hi\u1ec7p h\u1ed9i \u0111\u1ed3ng thu\u1eadn M\u1ef9-\u00c2u v\u00e0o n\u0103m 1994. \u0110\u1ec3 gi\u1ea3i quy\u1ebft nh\u1eefng h\u1ea1n ch\u1ebf v\u1ec1 \u0111\u1ecbnh ngh\u0129a ARDS tr\u01b0\u1edbc \u0111\u00e2y, hi\u1ec7n nay ng\u01b0\u1eddi ta \u0111\u01b0a ra \u0111\u1ecbnh ngh\u0129a Berlin (b\u1ea3ng 2) v\u00e0o n\u0103m 2012, v\u1edbi s\u1ef1 \u0111\u1ed3ng thu\u1eadn c\u1ee7a c\u00e1c chuy\u00ean gia. M\u1ed9t l\u1ee3i \u00edch c\u1ee7a \u0111\u1ecbnh ngh\u0129a ti\u00eau chu\u1ea9n ARDS l\u00e0 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n d\u1ec5 d\u00e0ng b\u1ed5 sung v\u00e0o c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng gi\u00fap ph\u00e1t tri\u1ec3n c\u00e1c li\u1ec7u ph\u00e1p h\u1ed7 tr\u1ee3 hi\u1ec7u qu\u1ea3. M\u1ed9t \u0111\u1ecbnh ngh\u0129a ti\u00eau chu\u1ea9n ARDS c\u0169ng cho ph\u00e9p c\u00e1c b\u00e1c s\u0129 d\u1ec5 d\u00e0ng hi\u1ec3u qu\u1ea7n th\u1ec3 \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn trong m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u00e0 do \u0111\u00f3 \u00e1p d\u1ee5ng c\u00e1c b\u1eb1ng ch\u1ee9ng thu \u0111\u01b0\u1ee3c t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m \u0111\u00f3 \u0111\u1ec3 ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p tr\u00ean l\u00e2m s\u00e0ng. B\u1ec7nh nh\u00e2n ARDS \u0111\u1ea1i di\u1ec7n cho m\u1ed9t nh\u00f3m nh\u1ecf trong qu\u1ea9n th\u1ec3 l\u1edbn h\u01a1n b\u1ecb suy h\u00f4 h\u1ea5p gi\u1ea3m oxy m\u00e1u c\u1ea5p t\u00ednh. S\u1ef1 kh\u00e1c nhau gi\u1eefa ARDS v\u00e0 suy h\u00f4 h\u1ea5p gi\u1ea3m oxy m\u00e1u c\u1ea5p l\u00e0 ph\u1ea3i c\u00f3 th\u00e2m nhi\u1ec5m 2 ph\u1ebf tr\u01b0\u1eddng tr\u00ean phim ph\u1ed5i. B\u1eb1ng ch\u1ee9ng t\u1eeb nghi\u00ean c\u1ee9u AN TO\u00c0N CHO PH\u1ed4I (LUNG SAFE) ch\u1ee9ng minh c\u00e1c k\u1ebft c\u1ee5c t\u01b0\u01a1ng t\u1ef1 \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n th\u00e2m nhi\u1ec5m 1 b\u00ean hay 2 b\u00ean ph\u1ed5i cho th\u1ea5y kh\u00f4ng c\u1ea7n d\u00f9ng th\u00e2m nhi\u1ec5m 2 ph\u1ed5i nh\u01b0 m\u1ed9t ph\u1ea7n trong \u0111\u1ecbnh ngh\u0129a ARDS. C\u1ea7n nghi\u00ean c\u1ee9u th\u00eam \u0111\u1ec3 hi\u1ec3u r\u00f5 h\u01a1n nh\u1eefng \u0111i\u1ec3m t\u01b0\u01a1ng \u0111\u1ed3ng v\u00e0 kh\u00e1c bi\u1ec7t trong \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 sinh h\u1ecdc \u1edf b\u1ec7nh nh\u00e2n ARDS v\u00e0 suy h\u00f4 h\u1ea5p h\u1ea1 oxy m\u00e1u c\u1ea5p.<\/p>\n<p>Nghi\u00ean c\u1ee9u chi\u1ebfn l\u01b0\u1ee3c v\u00e0 l\u1ef1a ch\u1ecdn ti\u00eau chu\u1ea9n<\/p>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o cho b\u00e0i n\u00e0y \u0111\u01b0\u1ee3c l\u1ea5y t\u1eeb nh\u1eefng nghi\u00ean c\u1ee9u \u1edf c\u00e1c b\u00e0i b\u00e1o c\u00f4ng b\u1ed1 tr\u00ean PubMed l\u00fac b\u1eaft \u0111\u1ea7u c\u01a1 s\u1edf d\u1eef li\u1ec7u \u0111\u1ebfn 15\/07\/2022, d\u1ef1a tr\u00ean c\u00e1c thu\u1eadt ng\u1eef \u201cARDS\u201d, \u201cch\u1ea9n \u0111o\u00e1n\u201d, \u201ck\u1ebft c\u1ee5c\u201d, \u201cth\u00f4ng kh\u00ed\u201d, \u201c\u0111i\u1ec1u tr\u1ecb\u201d v\u00e0 \u201cc\u00e1c h\u01b0\u1edbng d\u1eabn\u201d. C\u00e1c ngu\u1ed3n t\u00e0i li\u1ec7u tham kh\u1ea3o li\u00ean quan \u0111\u01b0\u1ee3c tr\u00edch t\u1eeb nh\u1eefng nghi\u00ean c\u1ee9u c\u0169ng \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1. Ch\u00fang t\u00f4i t\u1eadp trung v\u00e0o nh\u1eefng nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng v\u00e0 danh s\u00e1ch cu\u1ed1i c\u00f9ng c\u00e1c b\u00e0i b\u00e1o \u0111\u01b0\u1ee3c tr\u00edch d\u1eabn l\u1ef1a ch\u1ecdn d\u1ef1a tr\u00ean m\u1ee9c \u0111\u1ed9 ph\u00f9 h\u1ee3p c\u1ee7a ch\u00fang v\u1edbi c\u00e1c m\u1ee5c ti\u00eau trong b\u00e0i \u0111\u00e1nh gi\u00e1 n\u00e0y. ClinicalTrials.gov c\u0169ng \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u s\u1eed d\u1ee5ng thu\u1eadt ng\u1eef \u201cARDS\u201d v\u00e0 m\u1ed9t lo\u1ea1t c\u00e1c th\u1eed nghi\u1ec7m \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn.<\/p>\n<p>B\u1ea3ng 1: ARDS do COVID19 so v\u1edbi ARDS do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c &#8211; t\u00f3m t\u1eaft c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m ch\u00ednh:<\/p>\n<ul>\n<li>Th\u1eddi gian: kh\u1edfi ph\u00e1t c\u00f3 th\u1ec3 h\u01a1n 7 ng\u00e0y t\u1eeb l\u00fac nhi\u1ec5m SARS-COV-2 v\u00e0 kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng.<\/li>\n<li>Nh\u00e2n kh\u1ea9u h\u1ecdc: ch\u00eanh l\u1ec7ch \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o gi\u1eefa c\u00e1c qu\u1ea7n th\u1ec3 d\u00e2n t\u1ed9c kh\u00f4ng ph\u1ea3i ng\u01b0\u1eddi da tr\u1eafng v\u00e0 c\u00e1c nh\u00e2n vi\u00ean ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe.<\/li>\n<li>H\u00ecnh \u1ea3nh ng\u1ef1c: L\u00e1t c\u1eaft CT ng\u1ef1c ch\u1ed3ng l\u00ean nhau trong giai \u0111o\u1ea1n c\u1ea5p, nh\u01b0ng ch\u1ee7 y\u1ebfu d\u1ea1ng k\u00ednh m\u1edd lan t\u1ecfa 2 ph\u1ed5i trong ARDS do COVID19, c\u00f3 b\u1eb1ng ch\u1ee9ng b\u1ec7nh ph\u1ed5i k\u1ebd k\u00e9o d\u00e0i nh\u01b0ng kh\u00f4ng ch\u1eafc ch\u1eafn khi so v\u1edbi ARDS kh\u00f4ng do COVID19.10<\/li>\n<li>C\u01a1 ch\u1ebf h\u00f4 h\u1ea5p: c\u00e1c c\u01a1 ch\u1ebf h\u1ec7 h\u00f4 h\u1ea5p (bao g\u1ed3m s\u1ef1 gi\u00e3n n\u1edf, \u00e1p su\u1ea5t cao nguy\u00ean v\u00e0 \u00e1p l\u1ef1c \u0111\u1ea9y) \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 t\u01b0\u01a1ng t\u1ef1 nhau. 7\u20139,11<\/li>\n<li>C\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc: s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u gi\u1ea3m (ch\u1ee7 y\u1ebfu do gi\u1ea3m neutrophil) tr\u00ean b\u1ec7nh nh\u00e2n ARDS do COVID19, gi\u1ea3m IL-6 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o nh\u01b0ng t\u01b0\u01a1ng t\u1ef1 c\u00e1c c\u00e1c d\u1ea5u \u1ea5n vi\u00eam to\u00e0n th\u00e2n kh\u00e1c v\u00e0 suy ch\u1ee9c n\u0103ng c\u01a1 quan ngo\u00e0i ph\u1ed5i, ki\u1ec3u h\u00ecnh t\u0103ng vi\u00eam \u00edt ph\u1ed5 bi\u1ebfn.<\/li>\n<li>\u0110\u00f4ng m\u00e1u: s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o ti\u1ec3u c\u1ea7u v\u00e0 fibrinogen cao; th\u1eddi gian prothrombin gi\u1ea3m, th\u1eddi gian ho\u1ea1t h\u00f3a m\u1ed9t ph\u1ea7n thromboplastin tr\u00ean b\u1ec7nh nh\u00e2n COVID19 k\u00e9o d\u00e0i h\u01a1n b\u1ec7nh nh\u00e2n ARDS kh\u00f4ng do COVID19; D-dimer trong ARDS kh\u00f4ng do COVID19 cao h\u01a1n ARDS do COVID19; ARDS do COVID19 l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 m\u1eafc huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch s\u00e2u.<\/li>\n<li>Thu\u1ed1c: c\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong COVID19 n\u1eb7ng (g\u1ed3m c\u1ea3 ARDS do COVID19) l\u00e0 corticoide, ch\u1eb9n th\u1ee5 th\u1ec3 IL-6 ho\u1eb7c baricitinib (ch\u1ea5t \u1ee9c ch\u1ebf Janus Kinase); kh\u00f4ng c\u00f3 thu\u1ed1c \u0111\u1eb7c hi\u1ec7u \u0111i\u1ec1u tr\u1ecb ARDS do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3: s\u1ed1 l\u01b0\u1ee3ng b\u1eb1ng ch\u1ee9ng th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng tr\u1ef1c ti\u1ebfp li\u00ean quan qu\u1ea7n th\u1ec3 COVID19 c\u00f2n r\u1ea5t \u00edt; s\u1eed d\u1ee5ng c\u00e1c th\u1ee7 thu\u1eadt huy \u0111\u1ed9ng, n\u1eb1m s\u1ea5p v\u00e0 phong b\u1ebf th\u1ea7n kinh c\u01a1 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o nhi\u1ec1u h\u01a1n tr\u00ean qu\u1ea7n th\u1ec3 ARDS do COVID19 h\u01a1n qu\u1ea7n th\u1ec3 ARDS kh\u00f4ng do COVID19. 7,11<\/li>\n<li>K\u1ebft c\u1ee5c ch\u0103m s\u00f3c t\u00edch c\u1ef1c: k\u00e9o d\u00e0i th\u1eddi gian th\u1edf m\u00e1y tr\u00ean b\u1ec7nh nh\u00e2n COVID19 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o; k\u1ebft c\u1ee5c t\u1eed vong t\u01b0\u01a1ng t\u1ef1 7,8,11<\/li>\n<li>K\u1ebft c\u1ee5c l\u00e2u d\u00e0i: kh\u00f4ng c\u00f3 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1ef7 l\u1ec7 t\u00e0n t\u1eadt trong 6 th\u00e1ng; t\u01b0\u01a1ng t\u1ef1 v\u1edbi ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng, t\u00e2m l\u00fd v\u00e0 ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c trong 6 th\u00e1ng; nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau COVID19 c\u00f3 t\u1ef7 l\u1ec7 tr\u1edf l\u1ea1i l\u00e0m vi\u1ec7c t\u0103ng l\u00ean trong 6 th\u00e1ng v\u00e0 1 n\u0103m \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o.<\/li>\n<\/ul>\n<p>B\u1ea3ng 2: \u0110\u1ecbnh ngh\u0129a Berlin \u0111\u1ed1i v\u1edbi h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p:<\/p>\n<ul>\n<li>Th\u1eddi gian: trong 1 tu\u1ea7n k\u1ec3 t\u1eeb khi c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng ho\u1eb7c c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p m\u1edbi xu\u1ea5t hi\u1ec7n hay tr\u1ea7m tr\u1ecdng h\u01a1n.<\/li>\n<li>H\u00ecnh \u1ea3nh ng\u1ef1c: (nh\u01b0 Xquang ng\u1ef1c ho\u1eb7c CT scan): c\u00e1c \u0111\u00e1m m\u1edd 2 b\u00ean ph\u1ed5i kh\u00f4ng \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch \u0111\u1ea7y \u0111\u1ee7 do tr\u00e0n d\u1ecbch, x\u1eb9p th\u00f9y ph\u1ed5i hay x\u1eb9p ph\u1ed5i ho\u1eb7c c\u00e1c n\u1ed1t u c\u1ee5c.<\/li>\n<li>Ngu\u1ed3n g\u1ed1c ph\u00f9: suy h\u00f4 h\u1ea5p kh\u00f4ng \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch \u0111\u1ea7y \u0111\u1ee7 do suy tim ho\u1eb7c qu\u00e1 t\u1ea3i d\u1ecbch; c\u1ea7n \u0111\u00e1nh gi\u00e1 kh\u00e1ch quan (nh\u01b0 si\u00eau \u00e2m tim) \u0111\u1ec3 lo\u1ea1i tr\u1eeb ph\u00f9 th\u1ee7y t\u0129nh n\u1ebfu kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1.<\/li>\n<li>Th\u1edf Oxy (n\u1ebfu \u0111\u1ed9 cao h\u01a1n 1000m, ph\u1ea3i t\u00ednh y\u1ebfu t\u1ed1 \u0111i\u1ec1u ch\u1ec9nh, s\u1eed d\u1ee5ng t\u1ef7 l\u1ec7 gi\u1eefa \u00e1p l\u1ef1c ri\u00eang ph\u1ea7n c\u1ee7a oxy trong m\u00e1u \u0111\u1ed9ng m\u1ea1ch [Pa02] v\u00e0 ph\u00e2n l\u01b0\u1ee3ng oxy h\u00edt v\u00e0o [FiO2] l\u00e0: [PaO2\/FiO2\u00d7 \u00e1p su\u1ea5t kh\u00ed quy\u1ec3n\/760)])<\/li>\n<li>Nh\u1eb9: 200 mmHg &gt;Pa02\/Fi02 \u2264300 mmHg v\u1edbi \u00e1p l\u1ef1c d\u01b0\u01a1ng cu\u1ed1i k\u1ef3 th\u1edf ra ho\u1eb7c \u00e1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf d\u01b0\u01a1ng li\u00ean t\u1ee5c \u22655 cm H2O (c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c v\u1eadn chuy\u1ec3n kh\u00f4ng x\u00e2m l\u1ea5n trong nh\u00f3m suy h\u00f4 h\u1ea5p c\u1ea5p nh\u1eb9)<\/li>\n<li>Trung b\u00ecnh: 100 mm Hg &gt; PaO2\/FiO2 \u2264200 mm Hg v\u1edbi \u00e1p l\u1ef1c d\u01b0\u01a1ng cu\u1ed1i k\u1ef3 th\u1edf ra \u22655 cm H2O<\/li>\n<li>N\u1eb7ng: PaO2\/FiO2 \u2264 100 mmHg v\u1edbi \u00e1p l\u1ef1c d\u01b0\u01a1ng cu\u1ed1i k\u1ef3 th\u1edf ra \u22655 cm H2O<\/li>\n<\/ul>\n<p>Nh\u1edd s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ch\u0103m s\u00f3c l\u00e2m s\u00e0ng v\u00e0 t\u0103ng nh\u1eadn th\u1ee9c ARDS l\u00e0 g\u00e1nh n\u1eb7ng to\u00e0n c\u1ea7u, xem x\u00e9t m\u1ed9t s\u1ed1 kh\u00eda c\u1ea1nh c\u1ee7a \u0111\u1ecbnh ngh\u0129a hi\u1ec7n t\u1ea1i h\u1ed9i ch\u1ee9ng ARDS, c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch h\u1eefu \u00edch trong \u0111\u1ecbnh ngh\u0129a ARDS c\u1eadp nh\u1eadt v\u00e0 mang t\u00ednh k\u1ecbp th\u1eddi. H\u00ecnh 1 t\u00f3m t\u1eaft ti\u00eau chu\u1ea9n ARDS \u0111\u00e3 ph\u00e1t tri\u1ec3n th\u1ebf n\u00e0o qua th\u1eddi gian v\u00e0 nh\u1eefng ti\u00eau chu\u1ea9n n\u00e0y s\u1ebd ph\u00e1t tri\u1ec3n ra sao trong t\u01b0\u01a1ng lai.<\/p>\n<p>Ti\u00eau chu\u1ea9n ch\u1ee5p Xquang ng\u1ef1c cho ARDS \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn c\u00f3 \u0111\u1ed9 tin c\u1eady d\u01b0\u1edbi m\u1ee9c t\u1ed1i \u01b0u qua c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t v\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn tr\u00ean b\u1ed1i c\u1ea3nh l\u00e2m s\u00e0ng. Trong c\u00e1c c\u01a1 s\u1edf nghi\u00ean c\u1ee9u, nh\u1eefng c\u00f4ng c\u1ee5 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n \u0111\u1ec3 c\u1ea3i thi\u1ec7n \u0111\u1ed9 tin c\u1eady trong ch\u1ea9n \u0111o\u00e1n ARDS. \u0110\u00e1nh gi\u00e1 Xquang v\u1ec1 thang \u0111i\u1ec3m ph\u00f9 ph\u1ed5i, s\u1eed d\u1ee5ng \u0111\u00e1nh gi\u00e1 tr\u1ef1c quang 4 g\u00f3c ph\u1ea7n t\u01b0 \u0111\u00f4ng \u0111\u1eb7c v\u00e0 \u0111\u1eadm \u0111\u1ed9 th\u00e2m nhi\u1ec5m, \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh t\u1ed1t qua c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t, c\u00f3 \u0111\u1ed9 tin c\u1eady v\u00e0 ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c cao ARDS. M\u1ed9t thang \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 tr\u1ef1c quan t\u01b0\u01a1ng t\u1ef1 \u0111\u00e3 ch\u1ee9ng minh t\u01b0\u01a1ng quan v\u1edbi k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng quan tr\u1ecdng nh\u01b0 t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 th\u1eddi gian n\u1eb1m t\u1ea1i \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c. C\u00f4ng ngh\u1ec7 tr\u00ed tu\u1ec7 nh\u00e2n t\u1ea1o (s\u1eed d\u1ee5ng m\u1ea1ng l\u01b0\u1edbi th\u1ea7n kinh ph\u1ee9c h\u1ee3p s\u00e2u c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u1ea1y \u0111\u1ec3 nh\u1eadn bi\u1ebft nh\u1eefng li\u00ean k\u1ebft tr\u00ean h\u00ecnh \u1ea3nh h\u1ecdc), nh\u01b0 C\u00f4ng c\u1ee5 x\u00e1c \u0111\u1ecbnh ARDS l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 n\u1eefa ch\u1ee9ng minh x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c \u0111\u00f4ng \u0111\u1eb7c 2 ph\u1ebf tr\u01b0\u1eddng ph\u00f9 h\u1ee3p v\u1edbi ARDS trong b\u1ed1i c\u1ea3nh nghi\u00ean c\u1ee9u nh\u01b0ng y\u00eau c\u1ea7u ph\u1ea3i c\u00f3 s\u1ef1 c\u00f4ng nh\u1eadn tr\u01b0\u1edbc khi \u00e1p d\u1ee5ng v\u00e0o l\u00e2m s\u00e0ng.<\/p>\n<p>Si\u00eau \u00e2m \u0111ang n\u1ed5i l\u00ean nh\u01b0 m\u1ed9t c\u00f4ng c\u1ee5 an to\u00e0n, ti\u1ebft ki\u1ec7m chi ph\u00ed, l\u00e0m t\u1ea1i gi\u01b0\u1eddng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ARDS m\u1eb7c d\u00f9 c\u1ea7n ph\u1ea3i \u0111\u00e0o t\u1ea1o tr\u01b0\u1edbc khi si\u00eau \u00e2m \u0111\u01b0\u1ee3c tri\u1ec3n khai nh\u01b0 m\u1ed9t c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh th\u00e2m nhi\u1ec5m ph\u1ed5i.<\/p>\n<figure id=\"attachment_34444\" aria-describedby=\"caption-attachment-34444\" style=\"width: 950px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-34444 size-full\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Hinh-1_-Dong-thoi-gian-tieu-chuan-ARDS-va-cac-huong-trong-tuong-lai.jpg\" alt=\"H\u00ecnh 1: D\u00f2ng th\u1eddi gian ti\u00eau chu\u1ea9n ARDS v\u00e0 c\u00e1c h\u01b0\u1edbng trong t\u01b0\u01a1ng lai\" width=\"950\" height=\"633\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Hinh-1_-Dong-thoi-gian-tieu-chuan-ARDS-va-cac-huong-trong-tuong-lai.jpg 950w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Hinh-1_-Dong-thoi-gian-tieu-chuan-ARDS-va-cac-huong-trong-tuong-lai-600x400.jpg 600w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Hinh-1_-Dong-thoi-gian-tieu-chuan-ARDS-va-cac-huong-trong-tuong-lai-768x512.jpg 768w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Hinh-1_-Dong-thoi-gian-tieu-chuan-ARDS-va-cac-huong-trong-tuong-lai-350x233.jpg 350w\" sizes=\"auto, (max-width: 950px) 100vw, 950px\" \/><figcaption id=\"caption-attachment-34444\" class=\"wp-caption-text\">H\u00ecnh 1: D\u00f2ng th\u1eddi gian ti\u00eau chu\u1ea9n ARDS v\u00e0 c\u00e1c h\u01b0\u1edbng trong t\u01b0\u01a1ng lai<\/figcaption><\/figure>\n<p>\u0110\u1ed3ng thu\u1eadn ti\u00eau chu\u1ea9n ARDS \u0111\u1ea7u ti\u00ean l\u00e0 t\u1ea1i AECC n\u0103m 1994, ti\u1ebfp theo l\u00e0 Ti\u00eau chu\u1ea9n \u0111\u1ed3ng thu\u1eadn Berlin n\u0103m 2012. Ti\u00eau chu\u1ea9n ARDS \u0111ang \u0111\u01b0\u1ee3c s\u1eeda \u0111\u1ed5i v\u00e0 c\u00e1c thay \u0111\u1ed5i ti\u1ec1m n\u0103ng \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong h\u00ecnh. T\u01b0\u01a1ng lai c\u1ee7a ARDS trong th\u1eddi \u0111\u1ea1i y h\u1ecdc ch\u00ednh x\u00e1c ph\u1ea5n \u0111\u1ea5u h\u01b0\u1edbng \u0111\u1ebfn c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c. AEEC: Ti\u00eau chu\u1ea9n \u0111\u1ed3ng thu\u1eadn M\u1ef9-\u00c2u. Pa02=\u00e1p su\u1ea5t ri\u00eang ph\u1ea7n oxy trong m\u00e1u \u0111\u1ed9ng m\u1ea1ch. FiO2=ph\u00e2n su\u1ea5t oxy h\u00edt v\u00e0o. SpO2=\u0111\u1ed9 b\u00e3o h\u00f2a oxy. ARDS=h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p. PEEP=\u00e1p l\u1ef1c d\u01b0\u01a1ng cu\u1ed1i k\u1ef3 th\u1edf ra.<\/p>\n<p>T\u1ef7 l\u1ec7 gi\u1eefa \u0111\u1ed9 b\u00e3o h\u00f2a oxy \u0111o b\u1eb1ng oximetry v\u00e0 ph\u00e2n l\u01b0\u1ee3ng oxy h\u00edt v\u00e0o (Sp02\/Fi02) l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf \u0111\u1ea7y h\u1ea5p d\u1eabn \u0111\u1ed1i v\u1edbi t\u1ef7 l\u1ec7 gi\u1eefa \u00e1p su\u1ea5t ri\u00eang ph\u1ea7n oxy \u0111\u1ed9ng m\u1ea1ch v\u00e0 FiO2 (PaO2\/FiO2) do t\u00ednh kh\u1ea3 d\u1ee5ng v\u00e0 an to\u00e0n. C\u00e1c c\u00f4ng c\u1ee5 t\u1ea1i gi\u01b0\u1eddng \u0111\u01a1n gi\u1ea3n c\u00f3 th\u1ec3 h\u1eefu \u00edch trong b\u1ed1i c\u1ea3nh h\u1ea1n ch\u1ebf ngu\u1ed3n l\u1ef1c v\u00e0 b\u00ean ngo\u00e0i \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c truy\u1ec1n th\u1ed1ng. B\u1eb1ng ch\u1ee9ng t\u1eeb c\u00e1c ph\u00e2n t\u00edch h\u1ed3i c\u1ee9u h\u1ed7 tr\u1ee3 kh\u1ea3 n\u0103ng c\u1ee7a t\u1ef7 l\u1ec7 Sp02\/ Fi02 \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n k\u1ebft c\u1ee5c b\u1ec7nh nh\u00e2n ARDS. Trong b\u1ed1i c\u1ea3nh ngu\u1ed3n l\u1ef1c h\u1ea1n ch\u1ebf, trong \u0111\u00f3 th\u1edf m\u00e1y, ph\u00e2n t\u00edch kh\u00ed m\u00e1u v\u00e0 Xquang ng\u1ef1c kh\u00f4ng s\u1eb5n c\u00f3, c\u1ea3i bi\u00ean Kigali s\u1eed d\u1ee5ng t\u1ef7 l\u1ec7 Sp02\/Fi02 v\u00e0 si\u00eau \u00e2m ph\u1ed5i \u0111\u01b0\u1ee3c \u0111\u1ec1 xu\u1ea5t v\u00e0 h\u1eefu \u00edch nh\u1eb1m \u0111\u00e1nh gi\u00e1 ARDS. Ngo\u00e0i ra c\u1ea3i bi\u00ean Kigali lo\u1ea1i b\u1ecf y\u00eau c\u1ea7u \u00e1p l\u1ef1c d\u01b0\u01a1ng cu\u1ed1i th\u00ec th\u1edf ra (PEEP) v\u00ec c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 m\u00e1y th\u1edf.<\/p>\n<p>Si\u00eau \u00e2m ph\u1ed5i v\u00e0 t\u1ef7 l\u1ec7 Sp02\/Fi02 c\u00f3 nh\u1eefng h\u1ea1n ch\u1ebf \u0111\u1ec3 tr\u1edf th\u00e0nh c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n ARDS. Si\u00eau \u00e2m ph\u1ed5i c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 qu\u00e1 cao ARDS. Vercesi v\u00e0 c\u00e1c \u0111\u1ed3ng nghi\u1ec7p, b\u00e1o c\u00e1o t\u1ef7 l\u1ec7 cao d\u01b0\u01a1ng t\u00ednh gi\u1ea3 khi so s\u00e1nh c\u1ea3i bi\u00ean Kigali v\u1edbi ti\u00eau chu\u1ea9n Berlin ARDS trong m\u1ed9t nghi\u00ean c\u1ee9u quan s\u00e1t \u0111\u01a1n trung t\u00e2m t\u1ea1i H\u00e0 Lan. T\u1ef7 l\u1ec7 d\u01b0\u01a1ng t\u00ednh gi\u1ea3 cao \u0111\u01b0\u1ee3c cho l\u00e0 do \u0111\u1ed9 nh\u1ea1y c\u1ee7a si\u00eau \u00e2m ph\u1ed5i trong x\u00e1c \u0111\u1ecbnh th\u00e2m nhi\u1ec5m m\u00f4 k\u1ebd v\u00e0 c\u00e1c thay \u0111\u1ed5i \u0111\u00f4ng \u0111\u1eb7c ph\u1ed5i. Ngo\u00e0i ra, \u0111\u1ecbnh l\u01b0\u1ee3ng oxy m\u00e1u \u0111\u1ed9ng m\u1ea1ch c\u00f3 th\u1ec3 l\u00e0m ch\u00eanh l\u1ec7ch khi x\u00e1c \u0111\u1ecbnh gi\u1ea3m oxy m\u00e1u \u1ea9n d\u1ea5u do m\u00e0u s\u1eafc da. C\u1ea7n c\u00f3 nh\u1eefng nghi\u00ean c\u1ee9u ti\u1ec1n c\u1ee9u s\u00e2u h\u01a1n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ng\u01b0\u1ee1ng Sp02\/Fi02 t\u1ed1i \u01b0u cho m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng, s\u1ebd gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c s\u1ef1 kh\u00e1c bi\u1ec7t trong ch\u1ee7ng t\u1ed9c v\u00e0 ngu\u1ed3n g\u1ed1c d\u00e2n t\u1ed9c.<\/p>\n<p>Y\u00eau c\u1ea7u th\u00f4ng kh\u00ed \u00e1p l\u1ef1c d\u01b0\u01a1ng c\u00f3 ngh\u0129a l\u00e0 nhi\u1ec1u b\u1ec7nh nh\u00e2n suy h\u00f4 h\u1ea5p gi\u1ea3m oxy m\u00e1u c\u1ea5p kh\u00f4ng do tim v\u00e0 th\u00e2m nhi\u1ec5m 2 ph\u1ebf tr\u01b0\u1eddng kh\u00f4ng th\u1ec3 \u0111\u00e1p \u1ee9ng \u0111\u1ecbnh ngh\u0129a ARDS, m\u1eb7c d\u00f9 c\u00f3 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m sinh h\u1ecdc t\u01b0\u01a1ng t\u1ef1 v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m th\u00f4ng kh\u00ed \u00e1p l\u1ef1c d\u01b0\u01a1ng n\u00e0y. Cho t\u0103ng th\u1edf oxy m\u0169i l\u01b0u l\u01b0\u1ee3ng cao, c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m PEEP l\u00e0 m\u1ed9t l\u1ee3i \u00edch sinh l\u00fd, ng\u01b0\u1eddi ta quan t\u00e2m \u0111\u1ebfn th\u1edf oxy m\u0169i l\u01b0u l\u01b0\u1ee3ng cao trong \u0111\u1ecbnh ngh\u0129a ARDS trong t\u01b0\u01a1ng lai. M\u1ed9t s\u1eeda \u0111\u1ed5i \u0111\u1ed1i v\u1edbi th\u1edf oxy qua m\u0169i l\u01b0u l\u01b0\u1ee3ng cao trong \u0111\u1ecbnh ngh\u0129a ARDS s\u1ebd cho ph\u00e9p ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u00e2n ARDS v\u00e0 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i b\u1ed5 sung v\u00e0o c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng t\u1ea1i m\u1ed9t th\u1eddi \u0111i\u1ec3m s\u1edbm h\u01a1n trong di\u1ec5n ti\u1ebfn l\u00e2m s\u00e0ng c\u1ee7a ARDS. C\u00f3 nhi\u1ec1u h\u1ea1n ch\u1ebf ti\u1ec1m t\u00e0ng c\u1ee7a b\u1ea3n s\u1eeda \u0111\u1ed5i n\u00e0y. V\u00ed d\u1ee5, trong m\u1ed9t nghi\u00ean c\u1ee9u ti\u1ec1n c\u1ee9u \u0111\u01a1n trung t\u00e2m tr\u00ean 148 b\u1ec7nh nh\u00e2n, Pa02\/Fi02 \u0111\u01b0\u1ee3c ch\u1ee9ng minh thay \u0111\u1ed5i \u0111\u00e1ng k\u1ec3 sau khi chuy\u1ec3n h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p t\u1eeb th\u1edf oxy qua m\u0169i l\u01b0u l\u01b0\u1ee3ng cao sang th\u1edf m\u00e1y x\u00e2m l\u1ea5n. H\u01a1n th\u1ebf n\u1eefa, Ranieri v\u00e0 c\u00e1c \u0111\u1ed3ng nghi\u1ec7p cho th\u1ea5y c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng \u0111\u1ea7y \u0111\u1ee7 ti\u00eau chu\u1ea9n ARDS th\u1edf oxy m\u0169i l\u01b0u l\u01b0\u1ee3ng cao chuy\u1ec3n sang th\u1edf m\u00e1y x\u00e2m l\u1ea5n c\u00f3 th\u1ec3 c\u00f3 t\u1ef7 l\u1ec7 t\u1eed vong th\u1ea5p h\u01a1n nh\u1eefng b\u1ec7nh nh\u00e2n th\u1edf m\u00e1y kh\u00f4ng x\u00e2m l\u1ea5n m\u00e0 chuy\u1ec3n sang th\u1edf m\u00e1y x\u00e2m l\u1ea5n.<\/p>\n<figure id=\"attachment_34445\" aria-describedby=\"caption-attachment-34445\" style=\"width: 950px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-34445 size-full\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Huong-dan-cac-khuyen-cao-dieu-tri-ARDS-1.jpg\" alt=\"H\u01b0\u1edbng d\u1eabn c\u00e1c khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb ARDS \" width=\"950\" height=\"950\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Huong-dan-cac-khuyen-cao-dieu-tri-ARDS-1.jpg 950w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Huong-dan-cac-khuyen-cao-dieu-tri-ARDS-1-400x400.jpg 400w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Huong-dan-cac-khuyen-cao-dieu-tri-ARDS-1-800x800.jpg 800w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Huong-dan-cac-khuyen-cao-dieu-tri-ARDS-1-280x280.jpg 280w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Huong-dan-cac-khuyen-cao-dieu-tri-ARDS-1-768x768.jpg 768w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Huong-dan-cac-khuyen-cao-dieu-tri-ARDS-1-350x350.jpg 350w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Huong-dan-cac-khuyen-cao-dieu-tri-ARDS-1-100x100.jpg 100w\" sizes=\"auto, (max-width: 950px) 100vw, 950px\" \/><figcaption id=\"caption-attachment-34445\" class=\"wp-caption-text\">H\u01b0\u1edbng d\u1eabn c\u00e1c khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb ARDS<\/figcaption><\/figure>\n<p>Kh\u00f4ng c\u00f3 d\u1ea5u \u1ea5n sinh h\u1ecdc ARDS \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. The Berlin Task Force \u0111\u00e3 xem x\u00e9t c\u00e1c d\u1ea5n \u1ea5n sinh h\u1ecdc \u0111\u01b0a v\u00e0o b\u1ea3n s\u1eeda \u0111\u1ed5i ARDS tr\u01b0\u1edbc \u0111\u00f3 nh\u01b0ng ch\u00fang thi\u1ebfu \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7ch hi\u1ec7u \u0111\u1ec3 tr\u1edf th\u00e0nh c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n. Bos v\u00e0 c\u00e1c \u0111\u1ed3ng nghi\u1ec7p hi\u1ec7n nay \u0111\u00e3 xem x\u00e9t c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc ti\u1ec1m n\u0103ng c\u00f3 th\u1ec3 \u0111\u01b0a v\u00e0o ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n ARDS. C\u00e1c d\u1ea5u \u1ea5n t\u1ed5n th\u01b0\u01a1ng n\u1ed9i m\u00f4 bao g\u1ed3m \u0111\u00e1nh gi\u00e1 d\u1ecbch t\u1eeb m\u1ed9t b\u1ed9 l\u1ecdc trao \u0111\u1ed5i nhi\u1ec7t \u1ea9m, tuy nhi\u00ean k\u1ef9 thu\u1eadt n\u00e0y c\u1ea7n ph\u00ea chu\u1ea9n v\u1edbi nh\u1eefng k\u1ebft c\u1ee5c quan tr\u1ecdng ARDS.<\/p>\n<p>Ng\u00e0y c\u00e0ng c\u00f3 nhi\u1ec1u s\u1ef1 th\u1eeba nh\u1eadn nh\u1eefng h\u1ea1n ch\u1ebf c\u1ee7a m\u1ed9t \u0111\u1ecbnh ngh\u0129a h\u1ed9i ch\u1ee9ng, ph\u1edbt l\u1edd s\u1ef1 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t \u0111\u00e1ng k\u1ec3 v\u1ec1 sinh l\u00fd v\u00e0 sinh h\u1ecdc trong ARDS, \u0111\u00e3 th\u00fac \u0111\u1ea9y t\u1eadp trung v\u00e0o m\u00f4 h\u00ecnh m\u1edbi trong \u0111\u00f3 x\u00e1c \u0111\u1ecbnh c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m sinh h\u1ecdc c\u00f3 th\u1ec3 nh\u1eadn d\u1ea1ng v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c. Do \u0111\u00f3, c\u00e1c qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c ch\u1ee9 kh\u00f4ng ph\u1ea3i m\u1ed9t \u0111\u1ecbnh ngh\u0129a h\u1ed9i ch\u1ee9ng ARDS trong t\u01b0\u01a1ng lai. C\u00f4ng tr\u00ecnh ti\u00ean phong c\u1ee7a Calfee v\u00e0 \u0111\u1ed3ng nghi\u1ec7p \u0111\u00e3 x\u00e1c \u0111\u1ecbnh c\u00e1c ki\u1ec3u h\u00ecnh sinh h\u1ecdc c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb kh\u00e1c nhau. Nghi\u00ean c\u1ee9u PHIND (NCT04009330) m\u1ee5c ti\u00eau \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng th\u1eed nghi\u1ec7m t\u1ea1i \u0111i\u1ec3m ch\u0103m s\u00f3c \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c ki\u1ec3u h\u00ecnh c\u00f3 tri\u1ec3n v\u1ecdng n\u00e0y t\u1ea1i gi\u01b0\u1eddng. C\u00e1c ki\u1ec3u h\u00ecnh ARDS c\u0169ng x\u00e1c \u0111\u1ecbnh b\u1eb1ng m\u00f4 h\u00ecnh m\u00e1y h\u1ecdc nh\u1edd s\u1eed d\u1ee5ng th\u00f4ng tin l\u00e2m s\u00e0ng s\u1eb5n c\u00f3 th\u01b0\u1eddng xuy\u00ean, ch\u1ee9ng minh \u0111\u00e2y l\u00e0 c\u00f4ng c\u1ee5 h\u1eefu \u00edch \u0111\u1ec3 \u00e1p d\u1ee5ng v\u00e0o h\u1ec7 th\u1ed1ng y t\u1ebf \u0111i\u1ec7n t\u1eed nh\u1eb1m ph\u00e2n lo\u1ea1i b\u1ec7nh nh\u00e2n theo th\u1eddi gian th\u1ef1c. C\u00e1c ki\u1ec3u h\u00ecnh sinh h\u1ecdc, c\u00f9ng v\u1edbi nh\u1eefng d\u1eef li\u1ec7u n\u1ed5i b\u1eadt trong c\u00e1c nghi\u00ean c\u1ee9u gen v\u00e0 ki\u1ec3u h\u00ecnh mi\u1ec5n d\u1ecbch, c\u00f3 th\u1ec3 cung c\u1ea5p c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb trong ARDS v\u00e0 c\u00f3 c\u01a1 s\u1edf \u0111\u1ec3 \u0111\u01b0a v\u00e0o ti\u00eau chu\u1ea9n ARDS trong t\u01b0\u01a1ng lai. Vi\u1ec7n s\u1ee9c kh\u1ecfe qu\u1ed1c gia Anh g\u1ea7n \u0111\u00e2y \u0111\u01b0a l\u1eddi k\u00eau g\u1ecdi t\u00e0i tr\u1ee3 \u0111\u01a1n \u0111\u0103ng k\u00fd th\u00e0nh l\u1eadp t\u1ed5 h\u1ee3p ARDS, Vi\u00eam ph\u1ed5i v\u00e0 Nhi\u1ec5m tr\u00f9ng huy\u1ebft nh\u1eb1m t\u00ecm c\u00e1c \u0111i\u1ec3m kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t v\u00e0 c\u00e1c c\u01a1 ch\u1ebf c\u1ed1t l\u00f5i c\u1ee7a t\u00ecnh tr\u1ea1ng b\u1ec7nh hi\u1ec3m ngh\u00e8o n\u00e0y. S\u00e1ng ki\u1ebfn n\u00e0y l\u00e0 b\u01b0\u1edbc ti\u1ebfn quan tr\u1ecdng v\u1edbi ARDS theo y h\u1ecdc ch\u00ednh x\u00e1c. C\u00e1c ki\u1ec3u h\u00ecnh sinh h\u1ecdc n\u00e0y v\u00e0 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u0169ng c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n ngo\u00e0i ARDS v\u00e0 ph\u1ed5 bi\u1ebfn \u0111\u1ed1i v\u1edbi c\u00e1c h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng kh\u00e1c tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n nguy k\u1ecbch.<\/p>\n<h2>\u0110i\u1ec1u tr\u1ecb ARDS<\/h2>\n<p>B\u1ea3ng t\u1ed5ng k\u1ebft c\u00e1c h\u01b0\u1edbng d\u1eabn d\u1ef1a tr\u00ean y h\u1ecdc ch\u1ee9ng c\u1ee9 \u0111i\u1ec1u tr\u1ecb ARDS \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 t\u1ea1i Khoa h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c Anh v\u00e0 Hi\u1ec7p h\u1ed9i h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c, Hi\u1ec7p h\u1ed9i h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c Ph\u00e1p, c\u00f9ng s\u1ef1 \u0111\u1ed3ng h\u00e0nh c\u1ee7a hi\u1ec7p h\u1ed9i l\u1ed3ng ng\u1ef1c Hoa K\u1ef3, hi\u1ec7p h\u1ed9i h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c ch\u00e2u \u00c2u v\u00e0 Hi\u1ec7p h\u1ed9i y h\u1ecdc h\u1ed3i s\u1ee9c v\u00e0 c\u00e1c h\u01b0\u1edbng d\u1eabn s\u1ed1ng c\u1ee7a WHO \u0111\u1ed1i v\u1edbi ARDS do COVID19. M\u1ed9t b\u00e1o c\u00e1o g\u1ea7n \u0111\u00e2y c\u1ee7a chuy\u00ean gia t\u1ea1i Anh xem x\u00e9t \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 b\u1ec7nh nh\u00e2n ARDS do COVID19 n\u00ean tu\u00e2n theo c\u00e1c h\u01b0\u1edbng d\u1eabn ARDS d\u1ef1a tr\u00ean ch\u1ee9ng c\u1ee9 \u0111\u00e3 c\u00f3. \u1ede \u0111\u00e2y ch\u00fang t\u00f4i c\u00e2n nh\u1eafc b\u1eb1ng ch\u1ee9ng theo chi\u1ebfn l\u01b0\u1ee3c th\u00f4ng kh\u00ed, n\u1eb1m s\u1ea5p, h\u1ed7 tr\u1ee3 ngo\u00e0i c\u01a1 th\u1ec3, phong b\u1ebf th\u1ea7n kinh c\u01a1 v\u00e0 corticoide trong \u0111i\u1ec1u tr\u1ecb ARDS. C\u00e1c h\u01b0\u1edbng t\u01b0\u01a1ng lai trong can thi\u1ec7p ARDS c\u0169ng \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn (h\u00ecnh 2).<\/p>\n<figure id=\"attachment_34447\" aria-describedby=\"caption-attachment-34447\" style=\"width: 950px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-34447 size-full\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Hinh-2_-Cac-dac-diem-tiem-nang-co-the-dieu-tri-duoc-trong-ARDS-mot-mo-hinh-sinh-ly-benh-1.jpg\" alt=\"\u00ecnh 2: C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m ti\u1ec1m n\u0103ng c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c trong ARDS, m\u1ed9t m\u00f4 h\u00ecnh sinh l\u00fd b\u1ec7nh\" width=\"950\" height=\"633\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Hinh-2_-Cac-dac-diem-tiem-nang-co-the-dieu-tri-duoc-trong-ARDS-mot-mo-hinh-sinh-ly-benh-1.jpg 950w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Hinh-2_-Cac-dac-diem-tiem-nang-co-the-dieu-tri-duoc-trong-ARDS-mot-mo-hinh-sinh-ly-benh-1-600x400.jpg 600w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Hinh-2_-Cac-dac-diem-tiem-nang-co-the-dieu-tri-duoc-trong-ARDS-mot-mo-hinh-sinh-ly-benh-1-768x512.jpg 768w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2022\/10\/Hinh-2_-Cac-dac-diem-tiem-nang-co-the-dieu-tri-duoc-trong-ARDS-mot-mo-hinh-sinh-ly-benh-1-350x233.jpg 350w\" sizes=\"auto, (max-width: 950px) 100vw, 950px\" \/><figcaption id=\"caption-attachment-34447\" class=\"wp-caption-text\">H\u00ecnh 2: C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m ti\u1ec1m n\u0103ng c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c trong ARDS, m\u1ed9t m\u00f4 h\u00ecnh sinh l\u00fd b\u1ec7nh<\/figcaption><\/figure>\n<p>C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc (in nghi\u00eang), ph\u00f9 h\u1ee3p v\u1edbi c\u01a1 ch\u1ebf sinh l\u00fd b\u1ec7nh c\u01a1 b\u1ea3n v\u00e0 c\u00f3 th\u1ec3 nh\u1eafm tr\u00fang \u0111\u00edch b\u1eb1ng c\u00e1c li\u1ec7u ph\u00e1p \u0111\u1eb7c hi\u1ec7u ho\u1eb7c can thi\u1ec7p. Biomarkers \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 l\u00e0 c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc (v\u00ed d\u1ee5 thu \u0111\u01b0\u1ee3c t\u1eeb c\u00e1c m\u1eabu m\u00f4 sinh h\u1ecdc). C\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc thay th\u1ebf g\u1ed3m h\u00ecnh \u1ea3nh h\u1ecdc, sinh l\u00fd v\u00e0 d\u1eef li\u1ec7u l\u00e2m s\u00e0ng, khi ch\u00fang ph\u1ea3n \u00e1nh l\u1ea1i qu\u00e1 tr\u00ecnh sinh l\u00fd b\u1ec7nh c\u01a1 b\u1ea3n c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb. M\u00f4 h\u00ecnh sinh l\u00fd b\u1ec7nh m\u00f4 t\u1ea3 \u1edf \u0111\u00e2y c\u00f3 th\u1ec3 kh\u00f4ng t\u00ednh \u0111\u1ebfn m\u1ee9c \u0111\u1ed9 ph\u1ee9c t\u1ea1p v\u00e0 t\u01b0\u01a1ng t\u00e1c qua l\u1ea1i gi\u1eefa c\u00e1c c\u01a1 ch\u1ebf sinh l\u00fd b\u1ec7nh v\u00e0 \u0111\u00e1p \u1ee9ng c\u00e1 th\u1ec3 h\u00f3a tr\u00ean t\u1eebng b\u1ec7nh nh\u00e2n. Do t\u00edch h\u1ee3p nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p thu th\u1eadp th\u00f4ng tin (nh\u01b0 \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng, h\u00ecnh \u1ea3nh h\u1ecdc, sinh l\u00fd, c\u00e1c x\u00e9t nghi\u1ec7m sinh h\u1ecdc v\u00e0 d\u1eef li\u1ec7u v\u1ec1 gen) c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh th\u00eam nh\u1eefng ki\u1ec3u h\u00ecnh ph\u1ee5 nh\u1eb1m d\u1ef1 \u0111o\u00e1n thu\u1eadn l\u1ee3i \u0111\u00e1ng tin c\u1eady h\u01a1n v\u1edbi li\u1ec7u ph\u00e1p ho\u1eb7c can thi\u1ec7p. BALF = d\u1ecbch r\u1eeda ph\u1ebf qu\u1ea3n-ph\u1ebf nang.<\/p>\n<h2>C\u00e1c chi\u1ebfn l\u01b0\u1ee3c th\u00f4ng kh\u00ed<\/h2>\n<p>Th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i (nh\u01b0 th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng &lt;6 ml\/ kg, c\u00e2n n\u1eb7ng d\u1ef1 \u0111o\u00e1n v\u00e0 \u00e1p l\u1ef1c cao nguy\u00ean \u226430 mmHg) l\u00e0 khuy\u1ebfn c\u00e1o ch\u00ednh d\u1ef1a tr\u00ean nh\u1eefng k\u1ebft qu\u1ea3 t\u1eeb th\u1eed nghi\u1ec7m ARMA mang t\u00ednh b\u01b0\u1edbc ngo\u1eb7t, cho th\u1ea5y gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 t\u0103ng s\u1ed1 ng\u00e0y kh\u00f4ng th\u1edf m\u00e1y. C\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng (RCTs) c\u1ee7a chi\u1ebfn l\u01b0\u1ee3c th\u00f4ng kh\u00ed m\u1edbi ti\u1ebfp t\u1ee5c c\u1ee7ng c\u1ed1 l\u1ee3i \u00edch th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i. C\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng nghi\u00ean c\u1ee9u chi\u1ebfn l\u01b0\u1ee3c th\u00f4ng kh\u00ed thay th\u1ebf kh\u00f4ng cho th\u1ea5y l\u1ee3i \u00edch n\u00e0o n\u1eefa so v\u1edbi th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i. Th\u00f4ng kh\u00ed gi\u1ea3i ph\u00f3ng \u00e1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf l\u00e0 m\u1ed9t ph\u01b0\u01a1ng th\u1ee9c th\u00f4ng kh\u00ed ki\u1ec3m so\u00e1t \u00e1p l\u1ef1c c\u1ea3i ti\u1ebfn, cung c\u1ea5p \u00e1p l\u1ef1c cao k\u00e9o d\u00e0i kh\u00f4ng li\u00ean t\u1ee5c, theo chu k\u1ef3 th\u1eddi gian gi\u1ea3i ph\u00f3ng \u00e1p l\u1ef1c th\u1ea5p. \u0110a ph\u00e2n t\u00edch th\u00f4ng kh\u00ed gi\u1ea3i ph\u00f3ng \u00e1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf trong suy h\u00f4 h\u1ea5p h\u1ea1 oxy m\u00e1u c\u1ea5p (330 b\u1ec7nh nh\u00e2n trong 5 nghi\u00ean c\u1ee9u, 3 trong 5 nghi\u00ean c\u1ee9u l\u00e0 tr\u00ean b\u1ec7nh nh\u00e2n ARDS) cho th\u1ea5y t\u1ef7 l\u1ec7 t\u1eed vong trong b\u1ec7nh vi\u1ec7n, s\u1ed1 ng\u00e0y kh\u00f4ng th\u00f4ng kh\u00ed v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian n\u1eb1m ph\u00f2ng h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c. Tuy nhi\u00ean, c\u00e1c nghi\u00ean c\u1ee9u ti\u1ebfn h\u00e0nh \u0111\u1ebfn nay c\u00f3 nh\u1eefng h\u1ea1n ch\u1ebf v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p lu\u1eadn v\u00e0 c\u1ea7n m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng m\u1ea1nh m\u1ebd \u0111\u1ec3 gi\u1ea3i th\u00edch vai tr\u00f2 c\u1ee7a th\u00f4ng kh\u00ed gi\u1ea3i ph\u00f3ng \u00e1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf trong ARDS.<\/p>\n<p>C\u00e1c khuy\u1ebfn c\u00e1o theo h\u01b0\u1edbng d\u1eabn d\u00f9ng PEEP cao tr\u00ean b\u1ec7nh nh\u00e2n ARDS trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng. M\u1ed9t m\u1ea1ng l\u01b0\u1edbi \u0111a ph\u00e2n t\u00edch g\u1ea7n \u0111\u00e2y Bayesian \u0111\u00e1nh gi\u00e1 chi\u1ebfn l\u01b0\u1ee3c PEEP v\u00e0 th\u1ee7 thu\u1eadt huy \u0111\u1ed9ng ph\u1ebf nang trong ARDS trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng. K\u1ebft qu\u1ea3 ch\u00ednh c\u1ee7a ph\u00e2n t\u00edch n\u00e0y l\u00e0 chi\u1ebfn l\u01b0\u1ee3c PEEP cao kh\u00f4ng c\u00f3 th\u1ee7 thu\u1eadt huy \u0111\u1ed9ng ph\u1ebf nang ph\u1ed5i c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng c\u00f3 l\u1ee3i h\u01a1n so v\u1edbi chi\u1ebfn l\u01b0\u1ee3c PEEP th\u1ea5p (x\u00e1c su\u1ea5t l\u1ee3i \u00edch v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong l\u00e0 99%), trong khi \u0111\u00f3 k\u00e9o d\u00e0i th\u1ee7 thu\u1eadt huy \u0111\u1ed9ng ph\u1ebf nang b\u1eb1ng PEEP cao c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n h\u1ea1i so v\u1edbi PEEP cao m\u00e0 kh\u00f4ng huy \u0111\u1ed9ng ph\u1ebf nang (x\u00e1c su\u1ea5t t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong 99%). S\u1ef1 kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t trong c\u00e1 th\u1ec3 h\u00f3a b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng v\u1edbi PEEP \u0111\u01b0\u1ee3c ghi nh\u1eadn, v\u00e0 ng\u00e0y c\u00e0ng c\u00f3 nhi\u1ec1u quan t\u00e2m c\u00e1 th\u1ec3 h\u00f3a chi\u1ebfn l\u01b0\u1ee3c PEEP, m\u1eb7c d\u00f9 \u0111\u1ebfn nay \u0111i\u1ec1u n\u00e0y kh\u00f4ng mang l\u1ea1i l\u1ee3i \u00edch th\u00eam so v\u1edbi c\u00e1c chi\u1ebfn l\u01b0\u1ee3c th\u00f4ng kh\u00ed th\u00f4ng th\u01b0\u1eddng.<\/p>\n<p>\u00c1p l\u1ef1c \u0111\u1ea9y (v\u00ed d\u1ee5 \u00e1p l\u1ef1c cao nguy\u00ean tr\u1eeb \u00e1p l\u1ef1c cu\u1ed1i k\u00ec th\u1edf ra) c\u00f3 th\u1ec3 l\u00e0 c\u00f4ng c\u1ee5 d\u1ef1 \u0111o\u00e1n \u0111\u1ed9c l\u1eadp b\u1ec7nh nh\u00e2n ARDS s\u1ed1ng s\u00f3t. Amato v\u00e0 \u0111\u1ed3ng nghi\u1ec7p cho th\u1ea5y \u00e1p l\u1ef1c \u0111\u1ea9y l\u00e0 y\u00eau t\u1ed1 trung gian ch\u00ednh cho nh\u1eefng l\u1ee3i \u00edch c\u1ee7a PEEP v\u00e0 chi\u1ebfn l\u01b0\u1ee3c th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng. M\u1ed9t gi\u1edbi h\u1ea1n cao h\u01a1n 15 cmH20 \u0111\u1ed1i v\u1edbi \u00e1p l\u1ef1c \u0111\u1ea9y \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o, tr\u00ean \u0111\u00f3 g\u00e2y stress ph\u1ed5i. Ng\u01b0\u1ee3c l\u1ea1i, 2 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng b\u00e2y gi\u1edd \u0111\u00e3 cho th\u1ea5y t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong trong b\u1ed1i c\u1ea3nh \u00e1p l\u1ef1c \u0111\u1ea9y th\u1ea5p (\u226415 cm H2O), xem x\u00e9t \u00e1p l\u1ef1c \u0111\u1ea9y kh\u00f4ng h\u1eefu \u00edch nh\u01b0 mong \u0111\u1ee3i ban \u0111\u1ea7u d\u1ef1 \u0111o\u00e1n t\u1ef7 l\u1ec7 t\u1eed vong.<\/p>\n<p>C\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ti\u1ebfn h\u00e0nh nghi\u00ean c\u1ee9u chi\u1ebfn l\u01b0\u1ee3c PEEP nh\u1eafm tr\u00fang \u0111\u00edch t\u1edbi \u00e1p l\u1ef1c \u0111\u1ea9y (g\u1ed3m th\u1eed nghi\u1ec7m STAMINA NCT04972318) s\u1ebd b\u1ed5 sung th\u00f4ng tin quan tr\u1ecdng v\u1ec1 v\u1ea5n \u0111\u1ec1 n\u00e0y.<\/p>\n<p>M\u1ed9t kh\u00e1i ni\u1ec7m m\u1edbi \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng trong b\u1ed1i c\u1ea3nh ARDS l\u00e0 c\u00f4ng su\u1ea5t c\u01a1 h\u1ecdc. C\u00f4ng su\u1ea5t c\u01a1 h\u1ecdc l\u00e0 l\u01b0\u1ee3ng n\u0103ng l\u01b0\u1ee3ng truy\u1ec1n t\u1eeb m\u00e1y th\u1edf \u0111\u1ebfn h\u1ec7 h\u00f4 h\u1ea5p m\u1ed7i \u0111\u01a1n v\u1ecb th\u1eddi gian v\u00e0 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng hi\u1ec7u \u1ee9ng k\u1ebft h\u1ee3p c\u1ee7a th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng, \u00e1p l\u1ef1c \u0111\u1ea9y, t\u1ea7n s\u1ed1 th\u1edf, l\u01b0u l\u01b0\u1ee3ng kh\u00ed h\u00edt v\u00e0o v\u00e0 PEEP, c\u0169ng nh\u01b0 c\u00e1c y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh t\u00ednh ch\u1ea5t c\u01a1 h\u1ecdc c\u1ee7a ph\u1ed5i (v\u00ed d\u1ee5 \u0111\u1ed9 \u0111\u00e0n h\u1ed3i c\u1ee7a h\u1ec7 h\u00f4 h\u1ea5p v\u00e0 s\u1ee9c \u0111\u1ec1 kh\u00e1ng c\u1ee7a \u0111\u01b0\u1eddng th\u1edf). C\u00f4ng su\u1ea5t c\u01a1 h\u1ecdc \u0111\u01b0\u1ee3c t\u00ednh nh\u01b0 sau: C\u00f4ng su\u1ea5t c\u01a1 h\u1ecdc (J\/ph\u00fat) = 0.098 x Th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng x t\u1ea7n s\u1ed1 h\u1edf x [PEEP + (0.5 x \u00e1p l\u1ef1c \u0111\u1ea9y) + (\u00e1p l\u1ef1c \u0111\u1ec9nh &#8211; \u00e1p l\u1ef1c cao nguy\u00ean)]. C\u00f4ng su\u1ea5t c\u01a1 h\u1ecdc c\u00f3 th\u1ec3 l\u00e0 y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i t\u1ed1t h\u01a1n, so v\u1edbi c\u00e1c th\u00f4ng s\u1ed1 m\u00e1y th\u1edf ri\u00eang l\u1ebb, b\u1edfi v\u00ec n\u00f3 xem x\u00e9t c\u00e2n b\u1eb1ng c\u00e1c th\u00f4ng s\u1ed1 n\u00e0y tr\u00ean m\u1ed9t t\u1ed5ng th\u1ec3. Ph\u00e2n t\u00edch l\u1ea1i th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u00e0 th\u00f4ng tin quan s\u00e1t \u0111\u00e3 ch\u1ec9 ra c\u00f4ng su\u1ea5t c\u01a1 h\u1ecdc li\u00ean quan \u0111\u1ebfn k\u1ebft c\u1ee5c t\u1eed vong. Trong m\u1ed9t ph\u00e2n t\u00edch h\u1ed3i c\u1ee9u, tr\u00ean 8207 b\u1ec7nh nh\u00e2n, t\u0103ng nguy c\u01a1 t\u1eed vong m\u1ed9t c\u00e1ch nh\u1ea5t qu\u00e1n \u0111\u00e3 ch\u1ec9 ra c\u00f4ng su\u1ea5t c\u01a1 h\u1ecdc cao h\u01a1n 17 J\/ph\u00fat. S\u1ef1 ph\u1ee9c t\u1ea1p \u0111\u1ec3 gi\u1ea3i th\u00edch c\u00f4ng su\u1ea5t c\u01a1 h\u1ecdc l\u00e0m gi\u1edbi h\u1ea1n s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng m\u1eb7c d\u00f9 g\u1ea7n \u0111\u00e2y Costa v\u00e0 \u0111\u1ed3ng nghi\u1ec7p \u0111\u00e3 ph\u00e1t hi\u1ec7n c\u00e1c bi\u1ebfn th\u00e0nh ph\u1ea7n c\u1ee7a c\u00f4ng su\u1ea5t c\u01a1 h\u1ecdc d\u1ef1 \u0111o\u00e1n \u0111\u01b0\u1ee3c t\u1ef7 l\u1ec7 t\u1eed vong nhi\u1ec1u nh\u1ea5t, tr\u00ean th\u1ef1c t\u1ebf l\u00e0 \u00e1p l\u1ef1c \u0111\u1ea9y v\u00e0 t\u1ea7n s\u1ed1 th\u1edf. V\u00ec c\u00e1c bi\u1ebfn n\u00e0y c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng t\u00ednh \u0111\u01b0\u1ee3c ngay t\u1ea1i gi\u01b0\u1eddng, l\u1ee3i \u00edch b\u1ed5 sung c\u1ee7a c\u00f4ng su\u1ea5t c\u01a1 h\u1ecdc v\u1eabn ch\u01b0a ch\u1eafc ch\u1eafn.<\/p>\n<p>T\u00ednh kh\u00f4ng \u0111\u1ed3ng nh\u1ea5t c\u1ee7a hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb r\u1ea5t r\u00f5 r\u00e0ng trong c\u00e1c nghi\u00ean c\u1ee9u chi\u1ebfn l\u01b0\u1ee3c th\u1edf m\u00e1y \u0111i\u1ec1u tr\u1ecb ARDS v\u00e0 cho th\u1ea5y c\u00f3 th\u1ec3 c\u00f3 c\u00e1c ki\u1ec3u h\u00ecnh (ho\u1eb7c c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c) theo h\u01b0\u1edbng th\u1edf m\u00e1y c\u00e1 th\u1ec3 h\u00f3a. Costa v\u00e0 \u0111\u1ed3ng nghi\u1ec7p nh\u1eadn th\u1ea5y c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9 gi\u00e3n n\u1edf h\u1ec7 h\u00f4 h\u1ea5p th\u1ea5p c\u00f3 th\u1ec3 h\u01b0\u1edfng l\u1ee3i nhi\u1ec1u h\u01a1n t\u1eeb th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng v\u00e0 \u00e1p l\u1ef1c \u0111\u1ea9y th\u1ea5p, trong khi \u0111\u00f3 b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ed9 gi\u00e3n n\u1ee1 h\u1ec7 h\u00f4 h\u1ea5p cao \u0111\u01b0\u1ee3c d\u1ef1 \u0111o\u00e1n l\u1ee3i \u00edch cao h\u01a1n t\u1ea7n s\u1ed1 h\u00f4 h\u1ea5p th\u1ea5p. Trong m\u1ed9t ph\u00e2n t\u00edch l\u1ea1i th\u1eed nghi\u1ec7m EPVent-2 nghi\u00ean c\u1ee9u PEEP c\u00f3 h\u01b0\u1edbng d\u1eabn qua th\u1ef1c qu\u1ea3n trong ARDS, c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong ph\u1ee5 thu\u1ed9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh nh\u01b0 x\u00e1c \u0111\u1ecbnh trong thang \u0111i\u1ec3m APACHE II. T\u0103ng vi\u00eam v\u00e0 c\u00e1c ki\u1ec3u h\u00ecnh ph\u1ee5 gi\u1ea3m vi\u00eam c\u1ee7a ARDS c\u0169ng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00e0 \u0111\u00e1p \u1ee9ng v\u1edbi chi\u1ebfn l\u01b0\u1ee3c PEEP kh\u00e1c nhau. Nh\u1eefng k\u1ebft qu\u1ea3 t\u1eeb th\u1eed nghi\u1ec7m LIVE, nghi\u00ean c\u1ee9u th\u1edf m\u00e1y c\u00e1 th\u1ec3 h\u00f3a ph\u00f9 h\u1ee3p v\u1edbi h\u00ecnh th\u00e1i ph\u1ed5i tr\u00ean b\u1ec7nh nh\u00e2n ARDS, nh\u1ea5n m\u1ea1nh nhu c\u1ea7u \u0111i\u1ec1u ch\u1ec9nh ki\u1ec3u h\u00ecnh v\u1edbi c\u00e1c chi\u1ebfn l\u01b0\u1ee3c th\u00f4ng kh\u00ed tr\u00ean t\u1eebng b\u1ec7nh nh\u00e2n. Trong nghi\u00ean c\u1ee9u n\u00e0y, tr\u00ean b\u1ec7nh nh\u00e2n th\u1edf m\u00e1y kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi ki\u1ec3u h\u00ecnh ph\u1ed5i, cho th\u1ea5y t\u1ef7 l\u1ec7 t\u1eed vong t\u0103ng \u0111\u00e1ng k\u1ec3.<\/p>\n<h2>N\u1eb1m s\u1ea5p<\/h2>\n<p>N\u1eb1m s\u1ea5p tr\u00ean b\u1ec7nh nh\u00e2n ARDS c\u1ea3i thi\u1ec7n oxy h\u00f3a, t\u0103ng huy \u0111\u1ed9ng ph\u1ebf nang ti\u1ec1m n\u0103ng v\u00e0 gi\u1ea3m c\u00e1c v\u00f9ng ph\u1ebf gi\u00e3n qu\u00e1 m\u1ee9c, do \u0111\u00f3 \u0111\u1ea3m b\u1ea3o th\u00f4ng kh\u00ed ph\u1ed5i \u0111\u1ed3ng \u0111\u1ec1u h\u01a1n v\u00e0 nguy c\u01a1 th\u1edf m\u00e1y do t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i. D\u1eef li\u1ec7u t\u1eeb th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng \u0111a trung t\u00e2m PROSEVA, b\u1ec7nh nh\u00e2n ARDS n\u1eb7ng ph\u1ea3i th\u1edf m\u00e1y, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u1ef7 l\u1ec7 Pa02\/Fi02 &lt;150 mmHg sau th\u1eddi gian \u1ed5n \u0111\u1ecbnh ban \u0111\u1ea7u t\u1ed1i thi\u1ec3u 12h, n\u00ean \u0111\u01b0\u1ee3c th\u00f4ng kh\u00ed trong t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p \u00edt nh\u1ea5t 16h m\u1ed7i ng\u00e0y cho \u0111\u1ebfn khi l\u00e2m s\u00e0ng c\u1ea3i thi\u1ec7n. Th\u00f4ng kh\u00ed n\u1eb1m s\u1ea5p n\u00ean l\u00e0m s\u1edbm v\u00e0 l\u00fd t\u01b0\u1edfng nh\u1ea5t l\u00e0 36h sau khi \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau chu\u1ea9n. \u0110\u00e1ng ch\u00fa \u00fd, th\u00f4ng kh\u00ed n\u1eb1m s\u1ea5p n\u00ean l\u00e0m c\u00f9ng v\u1edbi chi\u1ebfn l\u01b0\u1ee3c th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i v\u00e0 th\u01b0\u1eddng d\u00f9ng tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n th\u1edf PEEP cao. N\u1eb1m s\u1ea5p li\u00ean quan c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 t\u1eed vong trong 28 ng\u00e0y (16% so v\u1edbi 33%, p&lt;0.0001), k\u00e9o d\u00e0i trong 90 ng\u00e0y (24% so v\u1edbi 41%, p&lt;0.0001). Thu th\u1eadp b\u1eb1ng ch\u1ee9ng t\u1eeb c\u00e1c th\u1eed nghi\u1ec7n l\u00e2m s\u00e0ng \u0111\u00e3 l\u00e0m tr\u01b0\u1edbc PROSEVA kh\u00f4ng \u1ee7ng h\u1ed9 \u00e1p d\u1ee5ng t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p ph\u1ed5 bi\u1ebfn trong ARDS \u00edt n\u1eb7ng. B\u1ea5t ch\u1ea5p b\u1eb1ng ch\u1ee9ng l\u1ee3i \u00edch trong th\u1eed nghi\u1ec7m PROSAVA, nghi\u00ean c\u1ee9u quan s\u00e1t qu\u1ed1c t\u1ebf ti\u1ec1n c\u1ee9u APRONET nh\u1eadn th\u1ea5y ch\u1ec9 1\/3 b\u1ec7nh nh\u00e2n ARDS n\u1eb7ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u1eb1m s\u1ea5p. T\u1ef7 l\u1ec7 n\u1eb1m s\u1ea5p th\u1ea5p m\u1ed9t ph\u1ea7n \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch do nh\u1eefng lo ng\u1ea1i c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i nh\u01b0 t\u1eaft \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n, lo\u00e9t t\u1ef3 \u0111\u00e8 v\u00e0 m\u1ea5t th\u00f4ng t\u0129nh m\u1ea1ch. Trong b\u1ed1i c\u1ea3nh ARDS do COVID19, n\u1eb1m s\u1ea5p \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n 1 c\u00e1ch an to\u00e0n v\u00e0 r\u1ed9ng r\u00e3i cho b\u1ec7nh nh\u00e2n th\u1edf m\u00e1y. Trong b\u1ed1i c\u1ea3nh COVID19, s\u1eed d\u1ee5ng n\u1eb1m s\u1ea5p \u0111\u01b0\u1ee3c m\u1edf r\u1ed9ng tr\u00ean b\u1ec7nh nh\u00e2n t\u1ec9nh t\u00e1o kh\u00f4ng th\u1edf m\u00e1y, nh\u01b0ng v\u1eabn c\u00f2n k\u1ebft qu\u1ea3 m\u00e2u thu\u1eabn t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m g\u1ea7n \u0111\u00e2y. Th\u1eddi gian n\u1eb1m s\u1ea5p trong c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y \u0111\u00e3 r\u00fat ng\u1eafn h\u01a1n so v\u1edbi th\u1eddi gian \u0111\u01b0\u1ee3c cho l\u00e0 c\u00f3 l\u1ee3i tr\u00ean b\u1ec7nh nh\u00e2n d\u00f9ng an th\u1ea7n v\u00e0 li\u1ec7t ph\u1ea3i th\u1edf m\u00e1y x\u00e2m l\u1ea5n, v\u00e0 th\u01b0\u1eddng gi\u1edbi h\u1ea1n tr\u00ean b\u1ec7nh nh\u00e2n b\u00ecnh th\u01b0\u1eddng. Kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng s\u1eed d\u1ee5ng n\u1eb1m s\u1ea5p tr\u00ean b\u1ec7nh nh\u00e2n t\u1ec9nh t\u00e1o kh\u00f4ng \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n c\u00f3 suy h\u00f4 h\u1ea5p h\u1ea1 oxy m\u00e1u c\u1ea5p do COVID19 v\u00e0 m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u0111\u1ec3 tr\u1ea3 l\u1eddi c\u00e2u h\u1ecfi n\u00e0y. Vai tr\u00f2 c\u1ee7a n\u1eb1m s\u1ea5p h\u1ed7 tr\u1ee3 oxy h\u00f3a qua m\u00e0ng ngo\u00e0i c\u01a1 th\u1ec3 (ECMO) c\u0169ng v\u1eabn kh\u00f4ng ch\u1eafc ch\u1eafn v\u00e0 l\u00e0 m\u1ed9t ch\u1ee7 \u0111\u1ec1 \u0111ang di\u1ec5n ra trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng (NCT4139733 v\u00e0 NCT04607551).<\/p>\n<h2>Phong b\u1ebf th\u1ea7n kinh c\u01a1<\/h2>\n<p>C\u00e1c h\u01b0\u1edbng d\u1eabn tr\u01b0\u1edbc \u0111\u00e2y \u0111\u01b0a ra khuy\u1ebfn c\u00e1o y\u1ebfu v\u1ec1 phong b\u1ebf th\u1ea7n kinh c\u01a1 tr\u00ean b\u1ec7nh nh\u00e2n ARDS trung b\u00ecnh &#8211; n\u1eb7ng, m\u1eb7c d\u00f9 nh\u1eefng gi\u1edbi h\u1ea1n v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p lu\u1eadn trong c\u00e1c b\u1eb1ng ch\u1ee9ng hi\u1ec7n c\u00f3 \u0111\u01b0\u1ee3c l\u01b0u \u00fd. G\u1ea7n \u0111\u00e2y h\u01a1n, th\u1eed nghi\u1ec7m ROSE (phong b\u1ebf th\u1ea7n kinh c\u01a1 giai \u0111o\u1ea1n s\u1edbm trong ARDS) nghi\u00ean c\u1ee9u vai tr\u00f2 c\u1ee7a phong b\u1ebf th\u1ea7n kinh c\u01a1 v\u1edbi thu\u1ed1c an th\u1ea7n s\u00e2u so v\u1edbi ch\u0103m s\u00f3c th\u00f4ng th\u01b0\u1eddng b\u1eb1ng an th\u1ea7n nh\u1eb9 tr\u00ean b\u1ec7nh nh\u00e2n ARDS trung b\u00ecnh &#8211; n\u1eb7ng. Th\u1eed nghi\u1ec7m \u0111\u00e3 ng\u01b0ng v\u00ec v\u00f4 \u00edch (k\u1ebft qu\u1ea3 thu \u0111\u01b0\u1ee3c t\u1eeb 1006 b\u1ec7nh nh\u00e2n) v\u00e0 cho th\u1ea5y kh\u00f4ng c\u00f3 kh\u00e1c bi\u1ec7t t\u1ef7 l\u1ec7 t\u1eed vong trong 90 ng\u00e0y. Tr\u00ean c\u01a1 s\u1edf b\u1eb1ng ch\u1ee9ng n\u00e0y, s\u1eed d\u1ee5ng th\u01b0\u1eddng xuy\u00ean phong b\u1ebf th\u1ea7n kinh c\u01a1 li\u00ean t\u1ee5c kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong m\u1ed9t nh\u00f3m b\u1ec7nh nh\u00e2n ARDS kh\u00f4ng \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn. Th\u1eed nghi\u1ec7m ROSE kh\u00f4ng \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c r\u1ed1i lo\u1ea1n \u0111\u1ed3ng b\u1ed9 m\u00e1y th\u1edf v\u00e0 17% b\u1ec7nh nh\u00e2n trong nh\u00f3m ch\u1ee9ng \u0111i\u1ec1u tr\u1ecb phong b\u1ebf th\u1ea7n kinh c\u01a1 trong 48h \u0111\u1ea7u, v\u00ec th\u1ebf c\u00f3 nh\u1eefng b\u1ec7nh nh\u00e2n v\u1eabn thu \u0111\u01b0\u1ee3c l\u1ee3i \u00edch t\u1eeb phong b\u1ebf th\u1ea7n kinh c\u01a1 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n \u0111\u1ed3ng b\u1ed9 th\u1edf m\u00e1y. H\u01a1n th\u1ebf n\u1eefa, gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n n\u1eb1m s\u1ea5p v\u00e0 ECMO trong th\u1eed nghi\u1ec7m ROSE, phong b\u1ebf th\u1ea7n kinh c\u01a1 c\u00f3 t\u01b0\u01a1ng t\u00e1c \u0111\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i mang l\u1ea1i l\u1ee3i \u00edch cho can thi\u1ec7p n\u00e0y v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec3u r\u00f5.<\/p>\n<h2>H\u1ed7 tr\u1ee3 ngo\u00e0i c\u01a1 th\u1ec3<\/h2>\n<p>Trong k\u1ef7 nguy\u00ean th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i, 2 nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng \u0111\u00e1nh gi\u00e1 vai tr\u00f2 c\u1ee7a ECMO t\u0129nh &#8211; t\u0129nh m\u1ea1ch tr\u00ean b\u1ec7nh nh\u00e2n ARDS n\u1eb7ng. Th\u1eed nghi\u1ec7m CESAR l\u00e0 m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng \u0111a trung t\u00e2m so s\u00e1nh \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng ARDS so v\u1edbi gi\u1edbi thi\u1ec7u \u0111\u1ebfn 1 trung t\u00e2m ECMO \u0111\u1ec3 xem x\u00e9t \u0111i\u1ec1u tr\u1ecb. Nh\u1eefng b\u1ec7nh nh\u00e2n ng\u1eabu nhi\u00ean gi\u1edbi thi\u1ec7u l\u00e0m ECMO, ch\u1ec9 76% (68\/90 b\u1ec7nh nh\u00e2n) \u0111\u01b0\u1ee3c l\u00e0m. Trong nh\u00f3m ng\u1eabu nhi\u00ean gi\u1edbi thi\u1ec7u l\u00e0m ECMO, c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c ch\u00ednh c\u1ee7a ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y sau 6 th\u00e1ng. Th\u1eed nghi\u1ec7m CESAR c\u00f3 nhi\u1ec1u h\u1ea1n ch\u1ebf \u0111\u00e1ng k\u1ec3 trong ph\u01b0\u01a1ng ph\u00e1p lu\u1eadn. Tuy nhi\u00ean, c\u00e1c h\u1ea1n ch\u1ebf n\u00e0y \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft nh\u1edd th\u1eed nghi\u1ec7m EOLIA, l\u00e0 m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng qu\u1ed1c t\u1ebf so s\u00e1nh ECMO v\u1edbi \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng, xem ECMO nh\u01b0 1 ph\u01b0\u01a1ng ph\u00e1p c\u1ee9u m\u1ea1ng n\u1ebfu c\u1ea7n. M\u1eb7c d\u00f9 k\u1ebft c\u1ee5c ch\u00ednh c\u1ee7a t\u1ef7 l\u1ec7 t\u1eed vong bao g\u1ed3m hi\u1ec7u qu\u1ea3 l\u1ee3i \u00edch \u0111i\u1ec1u tr\u1ecb ti\u1ec1m n\u0103ng (nguy c\u01a1 t\u01b0\u01a1ng \u0111\u1ed1i [RR] 0.76, 95% Cl 0.55-1.04, p=0,09), kh\u00f4ng c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea. M\u1ed9t ph\u00e2n t\u00edch s\u00e2u Bayesian cho th\u1ea5y c\u00f3 kh\u1ea3 n\u0103ng mang l\u1ea1i l\u1ee3i \u00edch r\u1ea5t cao n\u1ebfu d\u00f9ng ECMO s\u1edbm. H\u01a1n th\u1ebf n\u1eefa, trong m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p d\u1eef li\u1ec7u b\u1ec7nh nh\u00e2n c\u00e1 th\u1ec3 h\u00f3a ti\u1ebfp theo g\u1ed3m th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng CESAR v\u00e0 EOLIA, \u0111i\u1ec1u tr\u1ecb ch\u00ednh x\u00e1c \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n (d\u1eef li\u1ec7u g\u1ed9p 429 b\u1ec7nh nh\u00e2n) v\u00e0 l\u1ee3i \u00edch t\u1ef7 l\u1ec7 t\u1eed vong c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea trong 90 ng\u00e0y \u0111\u01b0\u1ee3c ch\u1ee9ng minh trong nh\u00f3m ECMO (RR 0.75, 95% Cl0.6-0,94, p=0,.013). C\u00f9ng v\u1edbi \u0111\u00f3, t\u1eeb nh\u1eefng d\u1eef li\u1ec7u c\u01a1 b\u1ea3n n\u00e0y, b\u1ec7nh nh\u00e2n ARDS n\u1eb7ng (\u0111\u1ecbnh ngh\u0129a l\u00e0 Pa02\/Fi02&lt;80 mmHg &gt;6h ho\u1eb7c suy h\u00f4 h\u1ea5pt\u0103ng CO2 n\u1eb7ng [v\u00ed d\u1ee5 pH&lt;7.25 v\u1edbi PaC02 \u226560 mmHg &gt;6 h]) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb ECMO. \u0110\u00e1ng ch\u00fa \u00fd, b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb ECMO nh\u00ecn chung c\u00f3 chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u01b0\u01a1ng t\u1ef1 v\u1edbi th\u1eed nghi\u1ec7m EOLIA. Cung c\u1ea5p ECMO r\u1ea5t ph\u1ee9c t\u1ea1p v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m t\u1ed5 ch\u1ee9c c\u1ee7a c\u00e1c trung t\u00e2m ECMO ph\u1ea3i ph\u00f9 h\u1ee3p v\u1edbi nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m t\u1ed5 ch\u1ee9c trong th\u1eed nghi\u1ec7m EOLIA ho\u1eb7c tu\u00e2n th\u1ee7 c\u00e1c ti\u00eau chu\u1ea9n trong trung t\u00e2m ECMO do c\u00e1c nh\u00f3m chuy\u00ean gia quy \u0111\u1ecbnh.<\/p>\n<p>B\u1eb1ng ch\u1ee9ng v\u1ec1 l\u1ee3i \u00edch c\u1ee7a ECMO \u0111\u01b0\u1ee3c ngo\u1ea1i suy trong qu\u1ea7n th\u1ec3 COVID19 v\u00e0 ECMO \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong t\u01b0\u01a1ng t\u1ef1 ECMO n\u00f3i chung s\u1eed d\u1ee5ng trong population of patients with non-COVID-19 ARDS.83 A recent large comparative effectiveness study showed m\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 tr\u00ean 7345 b\u1ec7nh nh\u00e2n m\u1eafc COVID19 kh\u1eafp 5 qu\u1ed1c gia. 844 b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ECMO v\u00e0 m\u1ed9t ph\u00e2n t\u00edch tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 Pa02\/Fi02 &lt;80 mmHg ch\u1ee9ng minh ECMO c\u00f3 li\u00ean quan gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong so v\u1edbi \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng (RR 0.78, 95% Cl 0.75-0.82). M\u1eb7c d\u00f9 x\u00e1c nh\u1eadn trong c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng, nh\u1eefng k\u1ebft qu\u1ea3 n\u00e0y mang l\u1ea1i s\u1ef1 y\u00ean t\u00e2m s\u1eed d\u1ee5ng ECMO trong 1 qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n ch\u1ecdn l\u1ecdc m\u1eafc COVID19 n\u1eb7ng. Lo\u1ea1i CO2 ngo\u00e0i c\u01a1 th\u1ec3 \u0111\u00e3 \u0111\u01b0\u1ee3c quan t\u00e2m trong c\u00e1c c\u01a1 s\u1edf nghi\u00ean c\u1ee9u \u0111\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n th\u1edf m\u00e1y v\u1edbi th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng th\u1ea5p. Th\u1eed nghi\u1ec7m REST, nghgieen c\u1ee9u lo\u1ea1i CO2 ngo\u00e0i c\u01a1 th\u1ec3 tr\u00ean b\u1ec7nh nh\u00e2n suy h\u00f4 h\u1ea5p h\u1ea1 oxy m\u00e1u c\u1ea5p cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1eed vong trong 90 ng\u00e0y v\u00e0 t\u0103ng t\u1ef7 l\u1ec7 m\u1eafc c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i, nh\u01b0 xu\u1ea5t huy\u1ebft nhi\u1ec1u tr\u00ean l\u00e2m s\u00e0ng, trong nh\u00f3m lo\u1ea1i CO2 ngo\u00e0i c\u01a1 th\u1ec3. Tr\u00ean c\u01a1 s\u1edf n\u00e0y, s\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p th\u1ea3i tr\u1eeb CO2 ngo\u00e0i c\u01a1 th\u1ec3 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ARDS kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o ngo\u00e0i c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng.<\/p>\n<h2>\u0110i\u1ec1u tr\u1ecb b\u1eb1ng Corticosteroid<\/h2>\n<p>Vai tr\u00f2 c\u1ee7a corticosteroide trong \u0111i\u1ec1u tr\u1ecb ARDS v\u1eabn c\u00f2n tranh lu\u1eadn l\u00e2u d\u00e0i. Steroide c\u00f3 t\u00e1c d\u1ee5ng kh\u00e1ng vi\u00eam m\u1ea1nh c\u00f3 th\u1ec3 mang l\u1ea1i l\u1ee3i \u00edch trong ARDS. M\u1ed9t b\u01b0\u1edbc ti\u1ebfn \u0111\u00e1ng k\u1ec3 trong \u0111\u1ea1i d\u1ecbch COVID19 \u0111ang cho th\u1ea5y l\u1ee3i \u00edch khi \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n COVID19 n\u1eb7ng b\u1eb1ng corticosteroide. Corticosteroide hi\u1ec7n nay l\u00e0 ti\u00eau chu\u1ea9n ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n ARDS do COVID19 v\u00e0 c\u00f3 s\u1ef1 quan t\u00e2m m\u1edbi v\u1ec1 vai tr\u00f2 c\u1ee7a steroide trong ARDS kh\u00f4ng do COVID19. Tr\u01b0\u1edbc \u0111\u1ea1i d\u1ecbch COVID19, nhi\u1ec1u nghi\u00ean c\u1ee9u th\u1ef1c hi\u1ec7n \u0111\u1ec3 hi\u1ec3u h\u01a1n vai tr\u00f2 c\u1ee7a corticosteroide trong ARDS. Th\u1eadt kh\u00f4ng may li\u1ec7u ph\u00e1p steroide r\u1ea5t kh\u00e1c nhau gi\u1eefa c\u00e1c nghi\u00ean c\u1ee9u (v\u00ed d\u1ee5 lo\u1ea1i, li\u1ec1u l\u01b0\u1ee3ng v\u00e0 th\u1eddi gian d\u00f9ng kh\u00e1c nhau) v\u00e0 c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t trong qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n nghi\u00ean c\u1ee9u (v\u00ed d\u1ee5 nh\u01b0 ARDS s\u1edbm vs mu\u1ed9n v\u00e0 m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u l\u00e0m xong tr\u01b0\u1edbc khi th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i). G\u1ea7n \u0111\u00e2y nh\u1ea5t, th\u1eed nghi\u1ec7m DEXA-ARDS nghi\u00ean c\u1ee9u dexam[1]ethasone li\u1ec1u cao (20mg 1 l\u1ea7n m\u1ed7i ng\u00e0y trong 5 ng\u00e0y) sau \u0111\u00f3 l\u00e0 li\u1ec1u th\u1ea5p (10mg 1 l\u1ea7n m\u1ed7i ng\u00e0y trong 5 ng\u00e0y) tr\u00ean b\u1ec7nh nh\u00e2n ARDS trung b\u00ecnh &#8211; n\u1eb7ng. Trong nh\u00f3m dexamethasone, s\u1ed1 ng\u00e0y kh\u00f4ng th\u1edf m\u00e1y t\u0103ng l\u00ean (gi\u1eefa c\u00e1c nh\u00f3m kh\u00e1c nhau 4.8 ng\u00e0y, 95% Cl 2.57-7.03, p&lt;0.0001) v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong trong 60 ng\u00e0y (21% vs 36%; gi\u1eefa nh\u00f3m kh\u00e1c 15.3%, 95% Cl -25.9 &#8211; 4.9, p=0.0047). M\u1ed9t \u0111a ph\u00e2n t\u00edch sau \u0111\u00f3 (999 b\u1ec7nh nh\u00e2n t\u1eeb 9 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng trong ARDS kh\u00f4ng do COVID19) cho th\u1ea5y l\u1ee3i \u00edch t\u1eed vong khi d\u00f9ng corticosteroide (RR 0.71, 95% Cl 0.54-0.92). C\u00f3 b\u1eb1ng ch\u1ee9ng li\u00ean quan t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft nh\u01b0ng kh\u00f4ng ph\u1ea3i b\u1eb1ng ch\u1ee9ng ch\u1eafc ch\u1eafn \u1ee7ng h\u1ed9 m\u1ed1i quan ng\u1ea1i v\u1ec1 c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i kh\u00e1c g\u1ed3m suy y\u1ebfu th\u1ea7n kinh c\u01a1, xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a ho\u1eb7c nhi\u1ec5m tr\u00f9ng. \u0110\u00e1ng ch\u00fa \u00fd, m\u1ed9t th\u1eed nghi\u1ec7m s\u1edbm nghi\u00ean c\u1ee9u methylprednisolone trong ARDS k\u00e9o d\u00e0i c\u00f3 li\u00ean quan t\u0103ng nguy c\u01a1 t\u1eed vong mu\u1ed9n (60 ng\u00e0y v\u00e0 180 ng\u00e0y) khi b\u1eaft \u0111\u1ea7u d\u00f9ng steroide sau 14 ng\u00e0y.<\/p>\n<p>\u0110\u00e1nh gi\u00e1 sai t\u1ef7 l\u1ec7 bi\u1ebfn c\u1ed1 d\u1ef1 \u0111o\u00e1n c\u00f3 th\u1ec3 ki\u1ec3m so\u00e1t v\u00e0 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb (d\u00f9ng \u0111\u1ec3 t\u00ednh to\u00e1n k\u00edch c\u1ee1 m\u1eabu) ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn l\u00e0 ph\u1ed5 bi\u1ebfn trong c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng ARDS v\u00e0 c\u00f3 th\u1ec3 g\u00f3p ph\u1ea7n v\u00e0o b\u1eb1ng ch\u1ee9ng kh\u00f4ng ch\u1eafc ch\u1eafn li\u00ean quan corticosteroide trong ARDS. S\u1eed d\u1ee5ng ph\u01b0\u01a1ng ph\u00e1p Bayesian, Saha v\u00e0 \u0111\u1ed3ng nghi\u1ec7p ch\u1ec9 ra b\u1eb1ng ch\u1ee9ng d\u00f9ng corticosteroide k\u00e9o d\u00e0i trong ARDS r\u1ea5t c\u00f3 \u00edch v\u00e0 h\u1ed7 tr\u1ee3 \u01b0u ti\u00ean trong c\u00e1c th\u1eed nghi\u1ec7m t\u01b0\u01a1ng lai nghi\u00ean c\u1ee9u corticosteroide tr\u00ean b\u1ec7nh nh\u00e2n ARDS kh\u00f4ng do COVID19.<\/p>\n<h2>C\u00e1c h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb trong t\u01b0\u01a1ng lai can thi\u1ec7p ARDS<\/h2>\n<p>Nhi\u1ec1u th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c tr\u00ean b\u1ec7nh nh\u00e2n ARDS ch\u01b0a mang l\u1ea1i hi\u1ec7u qu\u1ea3. C\u00e1c thu\u1ed1c c\u1ee5 th\u1ec3 v\u1eabn ch\u01b0a mang l\u1ea1i k\u1ebft qu\u1ea3 nh\u01b0 prostaglandin d\u1ea1ng h\u00edt, statin, asprin, surfactant, protein C ph\u1ea3n \u1ee9ng v\u00e0 Sivelestat. C\u00e1c thu\u1ed1c kh\u00e1c g\u1ed3m ch\u1ea5t ch\u1ee7 v\u1eadn beta2 v\u00e0 y\u00eau t\u1ed1 t\u0103ng tr\u01b0\u1edfng keratinocyte, l\u00e0 d\u1eef li\u1ec7u ti\u1ec1n l\u00e2m s\u00e0ng \u0111\u1ea7y h\u1ee9a h\u1eb9n, c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y h\u1ea1i ti\u1ec1m n\u0103ng.<\/p>\n<p>M\u1ed9t li\u1ec7u ph\u00e1p m\u1edbi \u0111\u00e1ng ch\u00fa \u00fd trong ARDS l\u00e0 t\u1ebf b\u00e0o \u0111\u1ec7m trung m\u00f4. C\u00e1c t\u1ebf b\u00e0o \u0111a n\u0103ng, k\u1ebft d\u00ednh, d\u1ebbo n\u00e0y c\u00f3 th\u1ec3 thu \u0111\u01b0\u1ee3c t\u1eeb nhi\u1ec1u ngu\u1ed3n nh\u01b0 t\u1ee7y x\u01b0\u01a1ng, d\u00e2y r\u1ed1n ho\u1eb7c m\u00f4 m\u1ee1 v\u00e0 c\u00f3 t\u00e1c d\u1ee5ng \u0111i\u1ec1u h\u00f2a mi\u1ec5n d\u1ecbch theo nhi\u1ec1u h\u01b0\u1edbng, b\u00f9 \u0111\u1eafp v\u00e0 kh\u00e1ng khu\u1ea9n. C\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng nghi\u00ean c\u1ee9u t\u1ebf b\u00e0o \u0111\u1ec7m trung m\u00f4 trong ARDS v\u00e0 COVID19 \u0111\u00e3 \u1ee7ng h\u1ed9 s\u1ef1 an to\u00e0n c\u1ee7a ch\u00fang, tuy nhi\u00ean ch\u01b0a x\u00e1c \u0111\u1ecbnh t\u00ednh hi\u1ec7u qu\u1ea3. M\u1eb7c d\u00f9 nhi\u1ec1u con \u0111\u01b0\u1eddng h\u1ea5p d\u1eabn trong \u0111a li\u1ec7u ph\u00e1p nh\u1eafm tr\u00fang \u0111\u00edch ARDS, t\u1ebf b\u00e0o \u0111\u1ec7m trung m\u00f4 \u0111\u01b0\u1ee3c bi\u1ebft c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng vi m\u00f4i tr\u01b0\u1eddng sinh h\u1ecdc v\u00e0 c\u0169ng c\u00f3 th\u1ec3 l\u00e0 v\u1ea5n \u0111\u1ec1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb kh\u00f4ng th\u1ed1ng nh\u1ea5t trong c\u00e1c ki\u1ec3u h\u00ecnh b\u1ec7nh nh\u00e2n kh\u00e1c nhau.<\/p>\n<p>S\u1ef1 quan t\u00e2m c\u00e1c ki\u1ec3u h\u00ecnh sinh h\u1ecdc v\u00e0 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb tr\u00ean b\u1ec7nh nh\u00e2n ARDS, c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng kh\u00e1c nhau v\u1edbi t\u1eebng li\u1ec7u ph\u00e1p can thi\u1ec7p, \u0111\u00e3 \u1ee7ng h\u1ed9 nh\u1eefng k\u1ebft qu\u1ea3 \u0111\u1ea7y h\u1ee9a h\u1eb9n t\u1eeb t\u00e1i ph\u00e2n t\u00edch nh\u1eefng th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u01b0\u1edbc \u0111\u00f3. Trong m\u1ed9t t\u00e1i ph\u00e2n t\u00edch th\u1eed nghi\u1ec7m HARP-2 (simvastatin d\u00e0nh cho ARDS) nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ki\u1ec3u h\u00ecnh t\u0103ng vi\u00eam v\u1edbi sivastatin \u0111\u01b0\u1ee3c nh\u1eadn th\u1ea5y c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t sau 28 ng\u00e0y.<\/p>\n<p>H\u00ecnh 2 ch\u1ee9ng minh c\u00e1c li\u1ec7u ph\u00e1p can thi\u1ec7p c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p v\u1edbi \u0111\u1eb7c \u0111i\u1ec3m c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb trong k\u1ef7 nguy\u00ean t\u01b0\u01a1ng lai c\u1ee7a y h\u1ecdc ch\u00ednh x\u00e1c ARDS. C\u1ea7n c\u00f3 nghi\u00ean c\u1ee9u chuy\u1ec3n d\u1ecbch li\u00ea t\u1ee5c \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb m\u1edbi. C\u0169ng c\u00f3 vai tr\u00f2 ti\u1ebfp c\u1eadn c\u00e1 th\u1ec3 h\u00f3a v\u1edbi can thi\u1ec7p hi\u1ec7n c\u00f3 trong ARDS v\u00e0 c\u00e1c b\u1ed9 d\u1eef li\u1ec7u s\u1eb5n c\u00f3 g\u00f3p ph\u1ea7n ch\u1ee9ng minh t\u00ednh h\u1eefu \u00edch x\u00e1c \u0111\u1ecbnh qu\u1ea7n th\u1ec3 \u0111\u00e1p \u1ee9ng nhanh nh\u1ea5t.<\/p>\n<p>C\u00f9ng v\u1edbi x\u00e1c \u0111\u1ecbnh g\u1ea7n \u0111\u00e2y c\u00e1c ki\u1ec3u h\u00ecnh sinh h\u1ecdc v\u00e0 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c, l\u1ee3i \u00edch c\u1ee7a nh\u1eefng th\u1eed nghi\u1ec7m n\u1ec1n t\u1ea3ng \u0111\u00e1p \u1ee9ng trong vi\u1ec7c x\u00e2y d\u1ef1ng \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 COVID19 \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n r\u00f5 r\u00e0ng. X\u00e2y d\u1ef1ng tr\u00ean n\u1ec1n t\u1ea3ng n\u00e0y th\u1eed nghi\u1ec7m I-SPY COVID19 x\u00e2y d\u1ef1ng m\u1ed9t th\u1eed nghi\u1ec7m n\u1ec1n t\u1ea3ng giai \u0111o\u1ea1n 2 nh\u1eb1m nghi\u00ean c\u1ee9u nh\u1eefng c\u00e1ch \u0111i\u1ec1u tr\u1ecb COVID19 m\u1edbi. \u0110\u1ec3 t\u1eadn d\u1ee5ng c\u00e1c ti\u1ebfn b\u1ed9 n\u00e0y, ng\u01b0\u1eddi ta nh\u1eadn th\u1ea5y t\u1ea7m quan tr\u1ecdng khi b\u1eaft \u0111\u1ea7u m\u1ed9t th\u1eed nghi\u1ec7m n\u1ec1n t\u1ea3ng pha 2 y h\u1ecdc ch\u00ednh x\u00e1c qu\u1ed1c t\u1ebf, c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c, \u0111\u1ec3 ki\u1ec3m tra c\u00e1c c\u00e1ch \u0111i\u1ec3u tr\u1ecb m\u1edbi tr\u00ean b\u1ec7nh nh\u00e2n ARDS. K\u1ebft h\u1ee3p gi\u1eefa c\u1ed9ng \u0111\u1ed3ng khoa h\u1ecdc to\u00e0n c\u1ea7u (g\u1ed3m c\u00e1c chuy\u00ean gia trong ARDS, y h\u1ecdc ch\u00ednh x\u00e1c v\u00e0 thi\u1ebft k\u1ebf th\u1eed nghi\u1ec7m th\u00edch \u1ee9ng) \u0111\u1ec3 th\u00fac \u0111\u1ea9y ch\u01b0\u01a1ng tr\u00ecnh nghi\u00ean c\u1ee9u n\u00e0y v\u1ec1 y h\u1ecdc ch\u00ednh x\u00e1c trong ARDS v\u1ec1 sau.<\/p>\n<h2>K\u1ebft c\u1ee5c c\u1ee7a b\u1ec7nh nh\u00e2n ARDS<\/h2>\n<p>Nghi\u00ean c\u1ee9u AN TO\u00c0N PH\u1ed4I l\u00e0 nghi\u00ean c\u1ee9u quan s\u00e1t l\u1edbn nh\u1ea5t v\u1ec1 d\u1ecbch t\u1ec5, m\u00f4 h\u00ecnh quan s\u00e1t v\u00e0 k\u1ebft c\u1ee5c l\u00e2m s\u00e0ng ARDS, th\u1ef1c hi\u1ec7n xong tr\u00ean 29144 b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb \u1edf 459 ph\u00f2ng h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c tr\u00ean 50 qu\u1ed1c gia kh\u1eafp 6 l\u1ee5c \u0111\u1ecba. 23% b\u1ec7nh nh\u00e2n th\u1edf m\u00e1y m\u1eafc ARDS. B\u1ec7nh nh\u00e2n ARDS c\u00f3 th\u1eddi gian th\u1edf m\u00e1y trung b\u00ecnh 8 ng\u00e0y, n\u1eb1m t\u1ea1i ph\u00f2ng h\u1ed3i s\u1ee9c trung b\u00ecnh 10 ng\u00e0y v\u00e0 n\u1eb1m vi\u1ec7n trung b\u00ecnh 17 ng\u00e0y. T\u1ef7 l\u1ec7 t\u1eed vong trong 28 ng\u00e0y l\u00e0 35% v\u00e0 t\u0103ng h\u1ea1 oxy m\u00e1u n\u1eb7ng v\u1edbi h\u01a1n 40% b\u1ec7nh nh\u00e2n ARDS n\u1eb7ng. Xem x\u00e9t s\u1ef1 kh\u00e1c nhau v\u1ec1 \u0111\u1ecba kinh t\u1ebf, PROVENT-iMiC (m\u1ed9t nghi\u00ean c\u1ee9u ti\u1ec1n c\u1ee9u qu\u1ed1c t\u1ebf \u0111a trung t\u00e2m tr\u00ean b\u1ec7nh nh\u00e2n th\u1edf m\u00e1y t\u1ea1i ph\u00f2ng h\u1ed3i s\u1ee9c \u1edf c\u00e1c n\u01b0\u1edbc ch\u00e2u \u00c1 c\u00f3 thu nh\u1eadp trung b\u00ecnh) cho th\u1ea5y t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n b\u1eaft \u0111\u1ea7u th\u1edf m\u00e1y th\u1ea5p h\u01a1n (7%) so v\u1edbi nghi\u00ean c\u1ee9u AN TO\u00c0N PH\u1ed4I. Th\u1ef1c h\u00e0nh th\u1edf m\u00e1y t\u01b0\u01a1ng t\u1ef1 nhau nh\u01b0ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t trong k\u1ebft c\u1ee5c bao g\u1ed3m t\u1ef7 l\u1ec7 t\u1eed vong t\u0103ng cao (45%), r\u00fat ng\u1eafn th\u1eddi gian n\u1eb1m vi\u1ec7n (trung b\u00ecnh 4 ng\u00e0y) v\u00e0 r\u00fat ng\u1eafn th\u1eddi gian n\u1eb1m \u1edf ICU (trung b\u00ecnh 5 ng\u00e0y) h\u01a1n nghi\u00ean c\u1ee9u AN TO\u00c0N PH\u1ed4I. Ch\u00eanh l\u1ec7ch c\u00f3 th\u1ec3 li\u00ean quan kh\u00e1c bi\u1ec7t v\u1ec1 kinh t\u1ebf \u0111\u1ecba l\u00fd trong t\u1eebng tr\u01b0\u1eddng h\u1ee3p ho\u1eb7c li\u00ean quan ngu\u1ed3n l\u1ef1c s\u1eb5n c\u00f3. T\u01b0\u01a1ng t\u1ef1, t\u1ef7 l\u1ec7 t\u1eed vong t\u0103ng qu\u00e1 m\u1ee9c tr\u00ean b\u1ec7nh nh\u00e2n ARDS \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n \u1edf c\u00e1c qu\u1ed1c gia thu nh\u1eadp th\u1ea5p v\u00e0 trung b\u00ecnh kh\u00e1c.<\/p>\n<p>K\u1ebft c\u1ee5c b\u1ec7nh nh\u00e2n trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u01b0a ra g\u00f3c nh\u00ecn kh\u00e1c v\u1ec1 k\u1ebft c\u1ee5c ARDS. M\u1ed9t \u0111\u00e1nh gi\u00e1 h\u1ec7 th\u1ed1ng t\u1ef7 l\u1ec7 t\u1eed vong trong 28 ng\u00e0y trong c\u00e1c nh\u00f3m ch\u1ee9ng th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ARDS cho th\u1ea5y t\u1ef7 l\u1ec7 t\u1eed vong l\u00e0 29% (t\u1eeb 26 th\u1eed nghi\u1ec7m tr\u00ean 2766 b\u1ec7nh nh\u00e2n trong giai \u0111o\u1ea1n 2016-2020). S\u1ef1 ch\u00eanh l\u1ec7ch gi\u1eefa k\u1ebft c\u1ee5c b\u1ec7nh nh\u00e2n ARDS trong th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u00e0 c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t \u0111\u01b0\u1ee3c ghi nh\u1eadn; th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng h\u1ea1n ch\u1ebf h\u01a1n trong l\u1ef1a ch\u1ecdn b\u1ec7nh nh\u00e2n v\u00e0 th\u00f4ng kh\u00ed b\u1ea3o v\u1ec7 ph\u1ed5i th\u01b0\u1eddng l\u00e0m nghi\u00eam ng\u1eb7t h\u01a1n. H\u01a1n th\u1ebf n\u1eefa, s\u1ef1 kh\u00f4ng th\u1ed1ng nh\u1ea5t k\u1ebft c\u1ee5c trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng (v\u00ed d\u1ee5 Juschten v\u00e0 \u0111\u1ed3ng nghi\u1ec7p cho th\u1ea5y t\u1ef7 l\u1ec7 t\u1eed vong kho\u1ea3ng 10-67% trong 1 \u0111\u00e1nh gi\u00e1 h\u1ec7 th\u1ed1ng 67 nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng t\u1eeb n\u0103m 2000-2019) v\u00e0 \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 h\u1ea1n ch\u1ebf k\u1ebft qu\u1ea3 th\u1eed nghi\u1ec7m v\u1edbi b\u1ed1i c\u1ea3nh l\u00e2m s\u00e0ng.<\/p>\n<p>M\u1eb7c d\u00f9 d\u1eef li\u1ec7u t\u1eeb th\u1eddi k\u1ef3 tr\u01b0\u1edbc COVID19 cho th\u1ea5y m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n ARDS t\u1eed vong do suy h\u00f4 h\u1ea5p kh\u00f4ng h\u1ed3i ph\u1ee5c (\u01b0\u1edbc t\u00ednh thay \u0111\u1ed5i d\u1ef1a v\u00e0o \u0111\u1ecbnh ngh\u0129a nh\u01b0ng \u0111\u01b0\u1ee3c ch\u1ee9ng minh &lt;1% v\u00e0 &lt;9%). ARDS c\u00f3 1 k\u1ebft qu\u1ea3 tr\u1ef1c ti\u1ebfp v\u00e0 c\u00f3 th\u1ec3 \u0111o l\u01b0\u1eddng \u0111\u01b0\u1ee3c t\u1ef7 l\u1ec7 t\u1eed vong. So v\u1edbi b\u1ec7nh nh\u00e2n n\u1eb1m \u1edf ICU kh\u00f4ng m\u1eafc ARDS, b\u1ec7nh nh\u00e2n ARDS t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong 15%. Trong b\u1ed1i c\u1ea3nh ARDS li\u00ean quan nhi\u1ec5m tr\u00f9ng huy\u1ebft, t\u1ef7 l\u1ec7 t\u1eed vong \u0111\u01b0\u1ee3c cho l\u00e0 37%. Trong m\u1ed9t nghi\u00ean c\u1ee9u \u0111o\u00e0n h\u1ec7 h\u1ed3i c\u1ee9u tr\u00ean 127 b\u1ec7nh nh\u00e2n ARDS, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng ph\u1ed5i \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y t\u1eed vong 28% (c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o g\u1ed3m nhi\u1ec5m tr\u00f9ng huy\u1ebft 17% v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim 10%).<\/p>\n<p>Xu h\u01b0\u1edbng d\u1ecbch t\u1ec5 v\u00e0 k\u1ebft c\u1ee5c tr\u00ean b\u1ec7nh nh\u00e2n ARDS lu\u00f4n bi\u1ebfn \u0111\u1ed9ng. Trong b\u1ed1i c\u1ea3nh \u0111\u1ea1i d\u1ecbch COVID19, \u01b0\u1edbc t\u00ednh t\u1ef7 l\u1ec7 m\u1eafc ARDS l\u1edbn h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi c\u00e1c b\u00e1o c\u00e1o tr\u01b0\u1edbc \u0111\u00e2y, v\u00e0 k\u1ebft c\u1ee5c thay \u0111\u1ed5i theo th\u1eddi gian v\u00e0 t\u00f9y b\u1ed1i c\u1ea3nh l\u00e2m s\u00e0ng. S\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 d\u00e2n t\u1ed9c v\u00e0 ch\u1ee7ng t\u1ed9c trong d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 k\u1ebft c\u1ee5c COVID19 \u0111\u00e3 r\u00f5 r\u00e0ng. Li\u1ec7u c\u00f3 th\u1ef1c h\u00e0nh n\u00e0o ngo\u1ea1i suy nh\u1eefng li\u1ec7u ph\u00e1p \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn mang l\u1ea1i l\u1ee3i \u00edch trong ARDS do COVID19 v\u1edbi ARDS do nguy\u00ean nh\u00e2n kh\u00e1c, th\u1eadm ch\u00ed khi kho\u1ea3ng tr\u1ed1ng b\u1eb1ng ch\u1ee9ng cho c\u00e1c li\u1ec7u ph\u00e1p n\u00e0y t\u1ed3n t\u1ea1i trong c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y suy h\u00f4 h\u1ea5p c\u1ea5p, v\u1eabn ch\u01b0a gi\u1ea3i th\u00edch th\u1ecfa \u0111\u00e1ng. H\u01a1n th\u1ebf n\u1eefa, COVID19 c\u00f3 t\u00e1c \u0111\u1ed9ng kh\u00f4n l\u01b0\u1eddng v\u1edbi h\u1ec7 th\u1ed1ng ch\u0103m s\u00f3c y t\u1ebf, \u0111\u1eb7c bi\u1ec7t c\u00e1c dich v\u1ee5 v\u1ec1 h\u00f4 h\u1ea5p v\u00e0 h\u1ed3i s\u1ee9c.Thay \u0111\u1ed5i trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng nh\u01b0 v\u1eady c\u00f3 th\u1ec3 thay \u0111\u1ed5i d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 k\u1ebft c\u1ee5c ARDS, trong t\u01b0\u01a1ng lai c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t ARDS d\u1ef1a tr\u00ean qu\u1ea7n th\u1ec3 l\u1edbn s\u1ebd ph\u1ea3i t\u00ecm hi\u1ec3u c\u00e1c \u0111i\u1ec1u kh\u00f4ng ch\u1eafc ch\u1eafn trong th\u1eddi k\u1ef3 h\u1eadu COVID19.<\/p>\n<h2>Di ch\u1ee9ng ARDS<\/h2>\n<p>C\u00e1c v\u1ea5n \u0111\u1ec1 m\u1edbi v\u00e0 t\u1ed3i t\u1ec7 h\u01a1n trong t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe th\u1ec3 ch\u1ea5t, nh\u1eadn th\u1ee9c ho\u1eb7c tinh th\u1ea7n th\u00ec th\u01b0\u1eddng g\u1eb7p tr\u00ean b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t sau ARDS. \u1ede \u0111\u00e2y, ch\u00fang t\u00f4i b\u00e0n v\u1ec1 b\u1eb1ng ch\u1ee9ng li\u00ean quan di ch\u1ee9ng l\u00e2u d\u00e0i v\u1edbi ARDS kh\u00f4ng do COVID19, ti\u1ebfp theo l\u00e0 b\u1eb1ng ch\u1ee9ng m\u1edbi n\u1ed5i trong ARDS. C\u00e1c d\u1ea5u hi\u1ec7u th\u01b0\u1eddng th\u1ea5y \u1edf nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau ARDS kh\u00f4ng do COVID19 g\u1ed3m tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p (kh\u00f3 th\u1edf, ho khan v\u00e0 ho \u0111\u00e1m) v\u00e0 gi\u1ea3m kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c. Tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p th\u01b0\u1eddng kh\u00f4ng t\u01b0\u01a1ng th\u00edch v\u1edbi m\u1ee9c \u0111\u1ed9 suy gi\u1ea3m ch\u1ee9c n\u0103ng ph\u1ed5i ho\u1eb7c m\u1ee9c \u0111\u1ed9 b\u1ea5t th\u01b0\u1eddng tr\u00ean Xquang. Nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau ARDS ti\u1ebfp t\u1ee5c tr\u1ea3i qua m\u1ed9t lo\u1ea1t c\u00e1c r\u1ed1i lo\u1ea1n th\u1ec3 ch\u1ea5t li\u00ean quan di ch\u1ee9ng c\u1ee7a b\u1ec7nh nguy k\u1ecbch (h\u1eb9p kh\u00ed qu\u1ea3n, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng d\u00e2y thanh \u00e2m, h\u1ee7y r\u0103ng v\u00e0 s\u1eb9o li\u00ean quan c\u00e1c can thi\u1ec7p). T\u1ef7 l\u1ec7 r\u1ed1i lo\u1ea1n c\u0103ng th\u1eb3ng h\u1eadu ch\u1ea5n th\u01b0\u01a1ng l\u00e0 cao tr\u00ean b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t sau ARDS v\u1edbi t\u1ef7 l\u1ec7 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o l\u00ean \u0111\u1ebfn 1\/4 b\u1ec7nh nh\u00e2n sau 8 n\u0103m. C\u00e1c tri\u1ec7u ch\u1ee9ng t\u00e2m th\u1ea7n dai d\u1eb3ng nh\u01b0 c\u0103ng th\u1eb3ng v\u00e0 lo \u00e2u \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o chi\u1ebfm 1\/2 b\u1ec7nh nh\u00e2n. Nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau ARDS \u0111\u01b0\u1ee3c ch\u1ee9ng minh suy gi\u1ea3m ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c, g\u1ed3m ch\u1ee9c n\u0103ng \u0111i\u1ec1u h\u00e0nh, gi\u1ea3i th\u00edch b\u1eb1ng l\u1eddi n\u00f3i v\u00e0 suy gi\u1ea3m s\u1ef1 ch\u00fa \u00fd.<\/p>\n<p>Do g\u00e1nh n\u1eb7ng v\u1ec1 c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ec3 ch\u1ea5t, tinh th\u1ea7n v\u00e0 nh\u1eadn th\u1ee9c tr\u00ean nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau ARDS, ng\u01b0\u1eddi ta th\u1ea5y gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng \u0111\u00e1ng k\u1ec3, gi\u1ea3m c\u01a1 h\u1ed9i vi\u1ec7c l\u00e0m v\u00e0 gi\u1ea3m h\u00f2a nh\u1eadp x\u00e3 h\u1ed9i.<\/p>\n<p>Kamdar v\u00e0 c\u1ed9ng s\u1ef1 ch\u1ee9ng minh 44% nh\u1eefng ng\u01b0\u1eddi c\u00f3 vi\u1ec7c l\u00e0m tr\u01b0\u1edbc \u0111\u00f3 s\u1ed1ng s\u00f3t sau ARDS b\u1ecb m\u1ea5t vi\u1ec7c sau 1 n\u0103m v\u00e0 5 n\u0103m l\u00e0 30% kh\u00f4ng bao gi\u1edd \u0111i l\u00e0m l\u1ea1i \u0111\u01b0\u1ee3c. Su v\u00e0 \u0111\u1ed3ng nghi\u1ec7p ch\u1ee9ng minh 1\/5 nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau ARDS tr\u1edf l\u1ea1i l\u00e0m vi\u1ec7c nh\u01b0ng h\u1ea7u nh\u01b0 nh\u01b0 kh\u00f4ng th\u1ec3 duy tr\u00ec c\u00f4ng vi\u1ec7c. Trong m\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c, Brown v\u00e0 \u0111\u1ed3ng nghi\u1ec7p cho th\u1ea5y ph\u1ea7n tr\u0103m nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau ARDS s\u1ed1ng \u0111\u1ed9c l\u1eadp t\u1ea1i nh\u00e0 trong 6 th\u00e1ng gi\u1ea3m t\u1eeb m\u1ee9c s\u1ed1ng c\u01a1 b\u1ea3n 91% xu\u1ed1ng c\u00f2n 45% trong 6 th\u00e1ng. S\u1eed d\u1ee5ng c\u00e1c ngu\u1ed3n l\u1ef1c y t\u1ebf gia t\u0103ng \u1edf nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau ARDS, t\u1ef7 l\u1ec7 nh\u1eadp vi\u1ec7n tr\u1edf l\u1ea1i t\u0103ng \u0111\u1ebfn 40% b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t, tr\u00ean 1\/3 s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u00f3 nh\u1eadp ICU. Nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau ARDS th\u01b0\u1eddng c\u00f3 nguy c\u01a1 cao t\u1eed vong trong su\u1ed1t qu\u00e1 tr\u00ecnh di\u1ec5n ti\u1ebfn \u0111\u1ee3t c\u1ea5p, nh\u01b0ng nguy c\u01a1 t\u1eed vong k\u00e9o d\u00e0i trong d\u00e0i h\u1ea1n. V\u00e0o n\u0103m \u0111\u1ea7u, t\u1ef7 l\u1ec7 t\u1eed vong t\u0103ng l\u00ean 11%, t\u0103ng 20-34% trong 5 n\u0103m sau. Trong m\u1ed9t so s\u00e1nh b\u1ec7nh nh\u00e2n suy h\u00f4 h\u1ea5p h\u1ea1 oxy m\u00e1u c\u1ea5p (nhi\u1ec1u ng\u01b0\u1eddi trong \u0111\u00f3 c\u00f3 kh\u1ea3 n\u0103ng m\u1eafc ARDS) v\u1edbi nh\u1eefng ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh kh\u00f4ng nh\u1eadp vi\u1ec7n, b\u1ec7nh nh\u00e2n suy h\u00f4 h\u1ea5p h\u1ea1 oxy m\u00e1u t\u0103ng g\u1ea5p 1.9 l\u1ea7n t\u1ef7 l\u1ec7 t\u1eed vong mu\u1ed9n. Nguy c\u01a1 t\u1eed vong mu\u1ed9n ch\u1ee7 y\u1ebfu do c\u00e1c bi\u1ebfn c\u1ed1 c\u1ea5p t\u00ednh, m\u1eb7c d\u00f9 kho\u1ea3ng 30% nguy c\u01a1 t\u1eed vong li\u00ean quan suy h\u00f4 h\u1ea5p h\u1ea1 oxy m\u00e1u.<\/p>\n<p>C\u00e1c b\u00e1o c\u00e1o k\u1ebft c\u1ee5c l\u00e2u d\u00e0i tr\u00ean b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t sau ARDS do COVID19 \u0111ang xu\u1ea5t hi\u1ec7n v\u00e0 cung c\u1ea5p b\u1eb1ng ch\u1ee9ng t\u00ecnh tr\u1ea1ng suy gi\u1ea3m th\u1ec3 ch\u1ea5t, tinh th\u1ea7n v\u00e0 nh\u1eadn th\u1ee9c. B\u1eb1ng ch\u1ee9ng b\u1ec7nh ph\u1ed5i k\u1ebd k\u00e9o d\u00e0i tr\u00ean b\u1ec7nh nh\u00e2n ARDS li\u00ean quan COVID19 ph\u1ea3i th\u1edf m\u00e1y \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o, nh\u01b0ng v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng v\u1ec1 s\u1ef1 li\u00ean quan c\u1ee7a b\u1eb1ng ch\u1ee9ng n\u00e0y v\u1edbi qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n ARDS kh\u00f4ng do COVID19. \u0110\u00e1ng ch\u00fa \u00fd, m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u ch\u1ec9 ra ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng li\u00ean quan s\u1ee9c kh\u1ecfe t\u1ed1t h\u01a1n v\u00e0 gia t\u0103ng t\u1ef7 l\u1ec7 quay l\u1ea1i l\u00e0m vi\u1ec7c tr\u00ean b\u1ec7nh nh\u00e2n ARDS do COVID19 so v\u1edbi qu\u1ea7n th\u1ec3 ARDS kh\u00f4ng do COVID19. Tuy nhi\u00ean, b\u1ec7nh nh\u00e2n ARDS do COVID19 t\u1ef1 b\u00e1o c\u00e1o t\u00ecnh tr\u1ea1ng khuy\u1ebft t\u1eadt th\u1ea5p v\u00e0 n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng li\u00ean quan s\u1ee9c kh\u1ecfe tr\u01b0\u1edbc khi nh\u1eadp ICU v\u00e0 do \u0111\u00f3 c\u00f3 kh\u1ea3 n\u0103ng c\u1ea3i thi\u1ec7n sau b\u1ec7nh hi\u1ec3m ngh\u00e8o cao h\u01a1n so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n ARDS kh\u00f4ng do COVID19. Khi \u0111i\u1ec1u ch\u1ec9nh c\u00e1c y\u1ebfu t\u1ed1 g\u00e2y nhi\u1ec5u ti\u1ec1m \u1ea9n l\u00fac ban \u0111\u1ea7u, Hodgson v\u00e0 \u0111\u1ed3ng nghi\u1ec7p ch\u1ee9ng minh t\u1ef7 l\u1ec7 m\u1eafc khuy\u1ebft t\u1eadt m\u1edbi, ch\u1ee9c n\u0103ng t\u00e2m l\u00fd v\u00e0 ch\u1ee9c n\u0103ng nh\u1eadn th\u1ee9c th\u00ec t\u01b0\u01a1ng t\u1ef1 nhau trong 6 th\u00e1ng gi\u1eefa b\u1ec7nh nh\u00e2n b\u1ec7nh n\u1eb7ng m\u1eafc ho\u1eb7c kh\u00f4ng m\u1eafc COVID19. S\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a COVID19 l\u00e2u d\u00e0i, c\u00e1c h\u1eadu qu\u1ea3 l\u00e2u d\u00e0i c\u1ee7a COVID19 tr\u00ean ch\u1ee9c n\u0103ng c\u01a1 quan (bao g\u1ed3m b\u1ec7nh ph\u1ed5i k\u1ebd v\u00e0 di ch\u1ee9ng tim m\u1ea1ch) l\u00e0m d\u1ea5y l\u00ean m\u1ed1i lo ng\u1ea1i v\u1ec1 to\u00e0n b\u1ed9 t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh tr\u00ean b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t sau ARDS li\u00ean quan COVID19.<\/p>\n<p>X\u00e1c \u0111\u1ecbnh c\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p, g\u1ed3m th\u1eddi gian ch\u0103m s\u00f3c t\u00edch c\u1ef1c sau h\u1ed3i s\u1ee9c, n\u00e2ng cao kh\u1ea3 n\u0103ng h\u1ed3i ph\u1ee5c sau c\u01a1n nguy k\u1ecbch, \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn nh\u01b0 l\u00e0 bi\u1ec7n ph\u00e1p \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u tr\u00ean b\u1ec7nh nh\u00e2n v\u00e0 ng\u01b0\u1eddi ch\u0103m s\u00f3c h\u1ecd. Trong 1 th\u1ed1ng k\u00ea t\u1ea1i c\u00e1c b\u1ec7nh vi\u1ec7n Anh l\u00e0m th\u1ee7 thu\u1eadt h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c, 74% cung c\u1ea5p c\u00e1c d\u1ecbch v\u1ee5 theo d\u00f5i ngo\u1ea1i tr\u00fa cho b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t sau b\u1ec7nh n\u1eb7ng v\u00e0 18% cung c\u1ea5p c\u00e1c ch\u01b0\u01a1ng tr\u00ecnh ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng. Tr\u00ean th\u1ebf gi\u1edbi, c\u00e1c b\u00e1o c\u00e1o theo d\u00f5i sau xu\u1ea5t vi\u1ec7n kh\u1ecfi khoa h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c kh\u00e1c nhau \u0111\u00e1ng k\u1ec3 v\u00e0 kh\u00f4ng c\u00f3 c\u00e1ch ti\u1ebfp c\u1eadn th\u1ed1ng nh\u1ea5t v\u1ec1 th\u1ef1c hi\u1ec7n c\u00e1c d\u1ecbch v\u1ee5 n\u00e0y. Nh\u1eefng ng\u01b0\u1eddi s\u1ed1ng s\u00f3t sau h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o c\u00f3 l\u1ee3i \u00edch nh\u1edd ch\u01b0\u01a1ng tr\u00ecnh ph\u1ee5c h\u1ed3i t\u1ea1i ph\u00f2ng h\u1ed3i s\u1ee9c v\u00e0 h\u1ed7 tr\u1ee3 nh\u01b0 nhau, nh\u01b0ng \u0111\u1ebfn nay kh\u00f4ng c\u00f3 can thi\u1ec7p d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng c\u1ea3i thi\u1ec7n k\u1ebft c\u1ee5c l\u00e2u d\u00e0i tr\u00ean b\u1ec7nh nh\u00e2n ARDS. T\u00ecnh tr\u1ea1ng s\u1ed1ng s\u00f3t sau h\u1ed3i s\u1ee9c v\u1eabn l\u00e0 m\u1ed9t l\u0129nh v\u1ef1c nghi\u00ean c\u1ee9u t\u00edch c\u1ef1c v\u1edbi c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111ang di\u1ec5n ra nghi\u00ean c\u1ee9u c\u00e1c can thi\u1ec7p ti\u1ec1m n\u0103ng x\u1ea3y ra khi n\u1eb1m t\u1ea1i khoa ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t sau h\u1ed3i s\u1ee9c v\u00e0 l\u00e0m theo c\u00e1ch ti\u1ebfp c\u1eadn tr\u1ef1c ti\u1ebfp ho\u1eb7c th\u1ef1c t\u1ebf v\u1edbi ch\u01b0\u01a1ng tr\u00ecnh h\u1ed7 tr\u1ee3 ph\u1ee5c h\u1ed3i. Quan tr\u1ecdng h\u01a1n h\u1ebft l\u00e0 c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ARDS trong t\u01b0\u01a1ng lai c\u0169ng n\u00ean bao g\u1ed3m nh\u1eefng k\u1ebft c\u1ee5c l\u00e2u d\u00e0i \u0111a chi\u1ec1u.<\/p>\n<h2>T\u00f3m l\u1ea1i<\/h2>\n<p>ARDS l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 suy h\u00f4 h\u1ea5p gi\u1ea3m oxy m\u00e1u c\u1ea5p k\u00e8m theo th\u00e2m nhi\u1ec5m 2 b\u00ean ph\u1ebf tr\u01b0\u1eddng tr\u00ean phim ph\u1ed5i. Ch\u00fang ta \u0111ang b\u01b0\u1edbc v\u00e0o th\u1eddi k\u1ef3 h\u1eadu \u0111\u1ea1i d\u1ecbch, b\u1ed1i c\u1ea3nh d\u1ecbch t\u1ec5 h\u1ecdc c\u1ee7a ARDS ch\u01b0a ch\u1eafc ch\u1eafn; tuy nhi\u00ean, b\u1ec7nh nh\u00e2n ARDS ti\u1ebfp t\u1ee5c c\u00f3 t\u1ef7 l\u1ec7 m\u1eafc v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong \u0111\u00e1ng k\u1ec3 trong ng\u1eafn v\u00e0 d\u00e0i h\u1ea1n. Ti\u00eau chu\u1ea9n ARDS \u0111ang \u0111\u01b0\u1ee3c s\u1eeda \u0111\u1ed5i v\u00e0 xem x\u00e9t nh\u1eefng h\u1ea1n ch\u1ebf c\u00f3 th\u1ec3 l\u00e0m s\u00e1ng t\u1ecf. B\u1eb1ng ch\u1ee9ng d\u1ef1a tr\u00ean ch\u0103m s\u00f3c h\u1ed7 tr\u1ee3 t\u1ed1i \u01b0u v\u00e0 c\u00e1c can thi\u1ec7p tr\u00ean ARDS ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u0111\u1ec3 gi\u1ea3i quy\u1ebft c\u00e1c l\u0129nh v\u1ef1c kh\u00f4ng ch\u1eafc ch\u1eafn. V\u00ec ch\u00fang ta \u0111ang b\u01b0\u1edbc v\u00e0o k\u1ef7 nguy\u00ean y h\u1ecdc ch\u00ednh x\u00e1c trong c\u00e1c b\u1ec7nh hi\u1ec3m ngh\u00e8o, t\u01b0\u01a1ng lai \u0111i\u1ec1u tr\u1ecb ARDS ph\u1ea5n \u0111\u1ea5u theo h\u01b0\u1edbng x\u00e1c \u0111\u1ecbnh nh\u1eefng ki\u1ec3u h\u00ecnh sinh h\u1ecdc v\u00e0 c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u0169ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb can thi\u1ec7p c\u00e1 th\u1ec3 h\u00f3a.<\/p>\n<p>Contributors<\/p>\n<p>EAG prepared the first draft of the manuscript and figures. DFM and CMO\u2019K reviewed and contributed to subsequent versions of the manuscript. All authors have reviewed and approved the final version.<\/p>\n<p>Declaration of interests<\/p>\n<p>EAG declares funding from the Wellcome Trust for work on a study investigating acute respiratory distress syndrome (ARDS) and COVID-19 and scholarship support from the American Thoracic Society to attend an American Thoracic Society meeting. DFM declares grants as an investigator in ARDS and COVID-19 studies from Wellcome Trust, the National Institute for Health and Care Research (NIHR), Innovate UK, the Medical Research Council, Novavax, and the Northern Ireland Health and Social Care Research and Development Fund; consultancy fees unrelated to this work from Bayer, GlaxoSmithKline, Boehringer Ingelheim, Novartis, and Eli Lilly; and payments from GlaxoSmithKline as an educational seminar speaker. DFM is a member of the data and safety monitoring board for Vir Biotechnology and Faron Pharmaceuticals; has a patent for a novel treatment for an inflammatory disease; is a director of research for the Intensive Care Society and director of the Efficacy and Mechanism Evaluation programme for the Medical Research Council and NIHR; declares a spouse who has received grants from Wellcome Trust and the Northern Ireland Health and Social Care Research and Development Fund; consultancy fees from INSMED and from the California Institute for Regenerative Medicine, unrelated to this Series paper. CMO\u2019K declares grants as an investigator on studies related to ARDS and COVID-19 from Wellcome Trust and the Northern Ireland Health and Social Care Research and Development Fund; consultancy fees from INSMED, unrelated to this work, and fees for participation in grant panels for the Californian Institute of Regenerative Medicine, unrelated to this Series paper. CMO\u2019K declares a spouse who has received grants from Wellcome Trust, the Northern Ireland Health and Social Care Research and Development Fund, NIHR, Innovate UK, the Medical Research Council, and Novavax; consultancy fees unrelated to this work from Bayer, GlaxoSmithKline, Boehringer Ingelheim, Novartis, and Eli Lilly; payments from GlaxoSmithKline as an educational seminar speaker; is a member of the data and safety monitoring board for Vir Biotechnology, Inc, and Faron Pharmaceuticals; has a patent for a novel treatment for an inflammatory disease; is a director of research for the Intensive Care Society and Director of the Efficacy and Mechanism Evaluation programme for the Medical Research Council and NIHR.<\/p>\n<p>Acknowledgments<\/p>\n<p>Figures included in this manuscript were created with BioRender.<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<ol>\n<li>Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. 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