Effect of a Protective-Ventilation Strategy on Mortality in the Acute Respiratory Distress Syndrome

Amato, Marcelo Britto Passos; Barbas, Carmen Sílvia Valente; Medeiros, Denise Machado; Magaldi, R; Schettino, Guilherme; Lorenzi-Filho, Geraldo; Kairalla, Ronaldo Adib; Deheinzelin, Daniel; Muñoz, Carlos Andres; Oliveira, Roselaine Pinheiro de; Takagaki, Teresa Yae; Carvalho, Carlos Roberto Ribeiro

doi:10.1056/nejm199802053380602

Cited by 3,202 publications

(2,205 citation statements)

References 40 publications

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“…were included in the final analysis. As a result of a meta‐analysis involving studies in which the influence of non‐PEEP interventions could not be ignored,203, 207, 211, 212 no significant difference in mortality rate was observed in the high PEEP group in comparison with the low PEEP group (risk ratio: 0.87, 95% CI: 0.74–1.02). In addition, when focusing the analysis on moderate or severe ARDS cases (PaO 2 /FiO 2 ratio ≤200 mmHg), the results of both the sub‐analyses including the studies permitting non‐PEEP interventions as well as the sub‐analyses excluding such interventions indicated that the high PEEP group exhibited a significantly lower mortality rate than the low PEEP group (risk ratio: 0.82, 95% CI: 0.73–0.92, risk ratio: 0.85, 95% CI: 0.75–0.96, respectively).…”

Section: Cq10: Management Of the Mechanically Ventilated Patientmentioning

confidence: 99%

“…As a result of the systematic review, only six 2013 Cochrane Review202‐adopted RCTs191, 203, 204, 205, 206, 207 involving the use of lung protective ventilation methods focusing primarily on low tidal volume in adult ARDS patients were identified. Mortality statistics were reported in all six studies ( n = 1,305), and while there was a difference in the follow‐up period, this period tended to be shorter in the low tidal volume group (risk ratio: 0.84, 95% confidence interval [CI]: 0.67–1.07).…”

Section: Cq10: Management Of the Mechanically Ventilated Patientmentioning

confidence: 99%

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Cq10: Management Of the Mechanically Ventilated Patientmentioning

confidence: 99%

Section: Cq10: Management Of the Mechanically Ventilated Patientmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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“…Application of Positive End-Expiratory Pressure (PEEP) is one of the most important intervention in managing a patient with ARDS [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…These treatments have been shown to reduce mortality in some cases [7,6]. However, there are still no well accepted and defined general procedures that can effectively optimize individual ventilator settings over broad cohorts.…”

Section: Introductionmentioning

confidence: 99%

A minimal model of lung mechanics and model-based markers for optimizing ventilator treatment in ARDS patients

Sundaresan

Yuta

Hann

et al. 2009

Computer Methods and Programs in Biomedicine

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A majority of patients admitted to the Intensive Care Unit (ICU) require some form of respiratory support. In the case of Acute Respiratory Distress Syndrome (ARDS), the patient often requires full intervention from a mechanical ventilator. ARDS is also associated with mortality rate as high as 70%. Despite many recent studies on ventilator treatment of the disease, there are no well established methods to determine the optimal Positive End Expiratory Pressure (PEEP) or other critical ventilator settings for individual patients. A model of fundamental lung mechanics is developed based on capturing the recruitment status of lung units. The main objective of this research is the simplest possible model that is clinically effective in determining PEEP. The model was identified for a variety of different ventilator settings using clinical data. The fitting error was between 0.1% to 4% over the inflation limb and between 0.3% to 13% over the deflation limb at different PEEP settings. The model produces good correlation with clinical data, and is clinically applicable due to the minimal number of patient specific parameters to identify. The ability to use this identified patient specific model to optimize ventilator management is demonstrated by its ability to predict the patient specific response of PEEP changes before clinically applying them. Predictions of recruited lung volume change with change in PEEP have a median absolute error of 1.87% (IQR:0.93-4.80%; 90% CI:0.16-11.98%) for inflation and a median of 5.76% (IQR:2.71-10.50%; 90% CI:0.43-17.04%) for deflation, across all data sets and PEEP values (N = 34 predictions). This minimal model thus provides a clinically useful and simple platform for continuous patient specific monitoring of lung unit recruitment for a patient.

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“…During the past few years, as a reaction to the high volumes and pressures applied during mechanical ventilation, the term "protective ventilation" [1][2][3] has been introduced. In our opinion, this expression is, however, deeply misleading, as the mechanical ventilation does not protect the lung from the development of the acute respiratory distress syndrome (ARDS), but simply aims to protect it from avoidable damage due to harmful ventilatory settings.…”

mentioning

confidence: 99%

Will all ARDS patients be receiving mechanical ventilation in 2035? We are not sure

2016

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Effect of a Protective-Ventilation Strategy on Mortality in the Acute Respiratory Distress Syndrome

Cited by 3,202 publications

References 40 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

A minimal model of lung mechanics and model-based markers for optimizing ventilator treatment in ARDS patients

Will all ARDS patients be receiving mechanical ventilation in 2035? We are not sure

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