Approach to the Patient with the Acute Respiratory Distress Syndrome

Janz, David R.; Ware, Lorraine B.

doi:10.1016/j.ccm.2014.08.007

Cited by 14 publications

(11 citation statements)

References 62 publications

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“…MV using large V T can result in over-distention of alveoli and lead to ventilator-induced lung injury (VILI), which can amplify the risk for lung injury 40,41 . Lung-protective MV refers to the use of low V T and positive end-expiratory pressure (PEEP) 11,18,19 . The ARMA study (or tidal volume study), a RCT reported in 2000 by the NHLBI ARDS Network, provided landmark evidence to support a lung-protective MV strategy in the presence of ARDS 11 .…”

Section: General Principlesmentioning

confidence: 99%

“…Evolving approaches to MV for patients at risk for ARDS and patients with ARDS have resulted in tangible improvements in outcomes 10–16 . Lung-protective MV strategies incorporating low tidal volumes (V T ) limit ventilator-induced lung injury (VILI), reduce morbidity in patients on MV and improve survival in patients with ARDS 8,11,17–19 . Guidelines embrace the use of lower V T in patients with ARDS 17 .…”

Section: Introductionmentioning

confidence: 99%

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Mechanical ventilation for the lung transplant recipient

et al. 2015

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Mechanical ventilation (MV) is an important aspect in the intraoperative and early postoperative management of lung transplant (LTx)-recipients. There are no randomized-controlled trials of LTx-recipient MV strategies; however there are LTx center experiences and international survey studies reported. The main early complication of LTx is primary graft dysfunction (PGD), which is similar to the adult respiratory distress syndrome (ARDS). We aim to summarize information pertinent to LTx-MV, as well as PGD, ARDS, and intraoperative MV and to synthesize these available data into recommendations. Based on the available evidence, we recommend lung-protective MV with low-tidal-volumes (≤6 mL/kg predicted body weight [PBW]) and positive end-expiratory pressure for the LTx-recipient. In our opinion, the MV strategy should be based on donor characteristics (donor PBW as a parameter of actual allograft size), rather than based on recipient characteristics; however this donor-characteristics-based protective MV is based on indirect evidence and requires validation in prospective clinical studies.

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Section: General Principlesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mechanical ventilation for the lung transplant recipient

et al. 2015

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“…Diffuse bilateral infiltrates are seen on a chest X-ray, which can be seen with pulmonary edema due to heart failure. However, the diagnosis of ARDS also requires exclusion of heart failure as a cause 3. The condition is so severe that nearly all patients are intubated and placed on mechanical ventilation due to acute respiratory failure, with mortality rates >30% 4…”

Section: Introductionmentioning

confidence: 99%

Establishing a Gradient between Partial Pressure of Arterial Carbon Dioxide and End-Tidal Carbon Dioxide in Patients with Acute Respiratory Distress Syndrome

Yousuf

Brinton

Murtaza

et al. 2017

Journal of Investigative Medicine

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End-tidal carbon dioxide (ETCO) monitoring is useful in many situations. However, ETCO monitoring is unreliable in patients with acute respiratory distress syndrome (ARDS) due to widespread lung inflammation. In our study, we attempt to establish the gradient between the arterial pressure of carbon dioxide (PaCO) and ETCO in patients with ARDS, which we defined as the PaETCO gradient. The main objective of the study was to establish a PaETCO gradient in each severity of ARDS. We analyzed 35 patients with ARDS and a total of 88 arterial blood gases were included. PaCO, PaO/FiO and ETCO were measured. Patients were stratified into mild, moderate and severe ARDS as classified by the Berlin ARDS criteria. PaCO and ETCO were compared at each severity stratification. The mean PaCO was 50.0, the mean ETCO was 26.6 and the gradient among all samples was 23.24 (±12.02). The mean gradient for each severity is as follows: mild: 19.3 (±9.9), moderate: 27.9 (±13.2) and severe: 23.9 (±7.8). The difference between the PaETCO gradient of the mild to moderate (p=0.001) and mild to severe groups (p=0.01) reached statistical significance. However, the difference between the moderate to severe groups did not reach statistical significance (p=0.48). We found the gradient between PaCO and ETCO in patients with ARDS is vast and tends to worsen with increasing severity of ARDS. This indicates that the gradient between the 2 may be used as an indicator of increasing severity of ARDS.

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“…The mortality rate in acute respiratory distress syndrome (ARDS) is as high as 40%, 1 and is a major cause of death in intensive care unit (ICU) patients. 2 Therefore, research on the pathogenesis of ARDS and the development of effective new drugs for the treatment of ARDS are very important.…”

Section: Introductionmentioning

confidence: 99%

Effect of rhubarb on extravascular lung water in patients with acute respiratory distress syndrome

et al. 2017

Rev. Assoc. Med. Bras.

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EffEct of rhubarb on Extravascular lung watEr in patiEnts with acutE rEspiratory distrEss syndromE reV assoC Med Bras 2017; 63 (5) Objective: The aim of this study was to evaluate the effect of rhubarb on extravascular lung water (EVLW) in patients with acute respiratory distress syndrome (ARDS). Method: A total of 80 patients with ARDS were randomly divided into a treatment group (40 cases) and control group (40 cases). Patients in the treatment group received rhubarb (30.0 g/d) and patients in the control group received conventional therapy for seven consecutive days. Extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were determined using pulse contour cardiac output (PiCCO) technology, and the oxygenation index was measured by blood gas analysis at baseline and on days 3, 5 and 7 after treatment. Results: The oxygenation index was higher and the levels of EVLWI and PVPI were lower after treatment in the two groups; however, these indexes showed significant differences on the 5 th and 7 th days after rhubarb treatment compared with the results in the control group (p<0.05). Conclusion: Rhubarb can decrease EVLWI and PVPI, and improve oxygenation in patients with ARDS.

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Approach to the Patient with the Acute Respiratory Distress Syndrome

Cited by 14 publications

References 62 publications

Mechanical ventilation for the lung transplant recipient

Mechanical ventilation for the lung transplant recipient

Establishing a Gradient between Partial Pressure of Arterial Carbon Dioxide and End-Tidal Carbon Dioxide in Patients with Acute Respiratory Distress Syndrome

Effect of rhubarb on extravascular lung water in patients with acute respiratory distress syndrome

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