By Lena M. Napolitano MD, Krishnan Raghavendran MD
This factor of serious Care Clinics will concentrate on serious Acute breathing misery Syndrome and working with it within the ICU. issues will comprise: demanding situations and Successes in ARDS Research;Mechanical air flow with Lung protecting techniques: What works?; Gene treatment for ALI/ARDS;High Frequency Oscillatory air flow in ALI/ARDS;Prone positioning remedy in ARDS;Recovery and long term final result in ARDS; and Experimental types and emergeing hypotheses for ALI and ARDS
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Extra info for ALI and ARDS: Challenges and Advances, An Issue of Critical Care Clinics (The Clinics: Internal Medicine)
However, 2 other clinical trials raised questions about this hypothesis, and the use of smaller tidal volumes is not always easy to do. The ARMA study was a randomized, controlled multicenter 2 Â 2 factorial study consisting of a drug treatment (ketoconazole vs placebo) and a ventilation strategy (6 mL/kg tidal volume vs 12 mL/kg tidal volume). The ventilator arm of the protocol was designed to compare different ventilator strategies (Fig. 2) and their effect on mortality and morbidity. The lower tidal volume 461 462 Thompson & Bernard Fig.
457 458 Blank & Napolitano 128. Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 2009;361(7):680–9. 129. Rello J, Rodriguez A, Ibanez P, et al. Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain. Crit Care 2009; 13(5):R148. 130. Jain S, Kamimoto L, Bramley AM, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009.
REFRACTORY HYPOXEMIA Some patients remain hypoxemic despite this initial management strategy. ” Fig. 4 shows an abbreviated version of an ARDS ventilator management strategy used at the University of Michigan, which begins with the ARDSnet low-VT management and proceeds through several strategies before ultimately considering extracorporeal membrane oxygenation. In addition to increasing FiO2, the ventilator response to hypoxemia is generally to increase mean airway pressure (Pmean) by increasing PEEP, lengthening inspiratory time (with an inspiratory pause in volume control ventilation or preferably directly using PCV), and increasing ventilating pressure.
ALI and ARDS: Challenges and Advances, An Issue of Critical Care Clinics (The Clinics: Internal Medicine) by Lena M. Napolitano MD, Krishnan Raghavendran MD