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By Jason Mann No BS pulmonary critical care fellow
Ryoichi Ochiai
Acute respiratory distress syndrome (ARDS) has been intensively and continuously studied in various settings, but its mortality is still as high as 30-40 %. For the last 20 years, lung protective strategy has become a standard care for ARDS, but we still do not know the best way to ventilate patients with ARDS. Tidal volume itself does not seem to have an important role to develop ventilator-induced lung injury (VILI), but the driving pressure, which is inspiratory plateau pressure-PEEP, is the most important to predict and affect the outcome of ARDS, though there is no safe limit for the driving pressure...
2015: Journal of Intensive Care
Nuttapol Rittayamai, Laurent Brochard
Acute respiratory distress syndrome (ARDS) is characterised by different degrees of severity and different stages. Understanding these differences can help to better adapt the ventilatory settings to protect the lung from ventilator-induced lung injury by reducing hyperinflation or keeping the lung open when it is possible. The same therapies may be useful and beneficial in certain forms of ARDS, and risky or harmful at other stages: this includes high positive end-expiratory pressure, allowance of spontaneous breathing activity or use of noninvasive ventilation...
March 2015: European Respiratory Review: An Official Journal of the European Respiratory Society
Matthieu Schmidt, Claire Stewart, Michael Bailey, Ania Nieszkowska, Joshua Kelly, Lorna Murphy, David Pilcher, D James Cooper, Carlos Scheinkestel, Vincent Pellegrino, Paul Forrest, Alain Combes, Carol Hodgson
OBJECTIVE: To describe mechanical ventilation settings in adult patients treated for an acute respiratory distress syndrome with extracorporeal membrane oxygenation and assess the potential impact of mechanical ventilation settings on ICU mortality. DESIGN: Retrospective observational study. SETTING: Three international high-volume extracorporeal membrane oxygenation centers. PATIENTS: A total of 168 patients treated with extracorporeal membrane oxygenation for severe acute respiratory distress syndrome from January 2007 to January 2013...
March 2015: Critical Care Medicine
J Claesson, M Freundlich, I Gunnarsson, J H Laake, P O Vandvik, T Varpula, T A Aasmundstad
BACKGROUND: The objective of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) task force on mechanical ventilation in adults with the acute respiratory distress syndrome (ARDS) is to formulate treatment recommendations based on available evidence from systematic reviews and randomised trials. METHODS: This guideline was developed according to standards for trustworthy guidelines through a systematic review of the literature and the use of the Grading of Recommendations Assessment, Development and Evaluation system for assessment of the quality of evidence and for moving from evidence to recommendations in a systematic and transparent process...
March 2015: Acta Anaesthesiologica Scandinavica
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