ARDS and ALI Archives - PulmCCM
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ARDS and ALI Articles

May 012016
 
ICU Physiology in 1,000 Words: ARDS - Part 2

Jon-Emile S. Kenny [@heart_lung] As mentioned in part 1, Gattinoni and Quintel have outlined their approach to managing the acute respiratory distress syndrome [ARDS] [1].  They argue that treatment of ARDS should minimize firstly, the mechanical power applied to the lungs – as described in part 1.  Secondly, Gattinoni and Quintel note that, in the [… read more]

Apr 222016
 
ICU Physiology in 1,000 Words: ARDS - Part 1

Jon-Emile S. Kenny [@heart_lung] “Often, as new knowledge progresses, old knowledge is abandoned or forgotten.” -Luciano Gattinoni In a succinct and current treatise, Gattinoni and Quintel outline the modern management of the acute respiratory distress syndrome [ARDS] [1].  It is imperative, they reason, that treatment of ARDS minimizes firstly, the mechanical power applied to the [… read more]

Mar 182016
 
The Physiologically Difficult Airway – Part 2

In part 2, I continue my commentary on this excellent review; part 1 may be found here.  In this post I will consider patients with severe metabolic acidosis and those with right ventricular [RV] dysfunction and/or failure. Severe Metabolic Acidosis In patients with severe metabolic acidosis, alveolar ventilation tends to be maximal as a compensatory mechanism.  [… read more]

Feb 132016
 
ICU Physiology in 1000 Words: Driving Pressure & Stress Index

By Jon-Emile S. Kenny [@heart_lung] The problem with the lung in the acute respiratory distress syndrome [ARDS] is not that it is stiff, but rather, that it is small [1].  In the 1980s, CT scans of the lungs of patients with ARDS revealed that the functional lung was attenuated in size and that dependent densities [… read more]

Sep 012014
 
ICU Physiology in 1000 Words: The Hemodynamics of Prone

ICU Physiology in 1,000 Words  “The Hemodynamics of Prone” by Jon-Emile S. Kenny MD A physiological maelstrom has recently swirled about the hemodynamic effects of the prone position in severe ARDS [1-5]; but how exactly does this maneuver alter the cardiovascular system?  A good approach to this problem is a Guytonian one whereby we consider [… read more]

Jul 112014
 
Prone positioning reduces ARDS mortality by 26%: meta-analysis

Image: Rotoprone Acute respiratory distress syndrome (ARDS) injures the lungs in a heterogeneous pattern, and the damaged areas are particularly vulnerable to further ventilator-induced lung injury. This is why a lung-protective ventilator strategy using low tidal volumes reduces mortality from ARDS, experts believe. Tidal volumes of 6 mL/kg ideal body weight (calculated from height) using conventional [… read more]

Feb 222014
 
Epitaph for nitric oxide for ARDS

Image: Dartmouth Nitric Oxide: No Benefit Even in Severe ARDS Giving inhaled nitric oxide to people with acute respiratory distress syndrome (ARDS) improves oxygenation, but has never been demonstrated to improve survival. Not many physicians seem to use nitric oxide for ARDS anymore, except possibly as salvage therapy in life-threatening refractory disease. Even that well-meaning [… read more]

Dec 082013
 
Ventilator-Induced Lung Injury Review (Part 2 of 2)

Prevention and Management of Ventilator-Induced Lung Injury See also Part 1: Mechanisms of Ventilator-Induced Lung Injury The recognition that lifesaving mechanical ventilation can also be harmful, even lethal, has led to a sea change in the use of mechanical ventilation in critically ill patients — at least in theory. For people with acute respiratory distress [… read more]

Dec 072013
 
Ventilator-Induced Lung Injury Review (Part 1 of 2)

Mechanisms of Ventilator-Induced Lung Injury (Part 1) See also Part 2: Prevention and Management of Ventilator-Induced Lung Injury Although invasive mechanical ventilation saves tens of thousands of lives each year, it can also be harmful, especially when misapplied. The repetitive stretching of lung tissue during positive pressure ventilation can damage fragile alveoli already made vulnerable [… read more]

Oct 062013
 
Mechanical ventilation in ARDS due to sepsis (Surviving Sepsis Guidelines)

Mechanical Ventilation in ARDS Due to Sepsis See All the Surviving Sepsis Guidelines Sepsis is one of the main causes of acute respiratory distress syndrome (ARDS), in which the lungs are injured by circulating inflammatory mediators, resulting in severely impaired gas exchange usually requiring invasive mechanical ventilation. ARDS also results in poor lung compliance in [… read more]

Aug 112013
 
Low tidal volume ventilation reduces complications from abdominal surgery

Low Tidal Volume Ventilation Improves Outcomes in Elective Surgery Using low tidal volumes (6-8 mL/kg ideal body weight, or about 500 mL in the average man) during mechanical ventilation has been known for more than a decade to be lifesaving for people with acute respiratory distress syndrome (ARDS). Since reducing mortality by a relative 22% [… read more]

Jun 022013
 
A turn for the best? Prone positioning saves lives in ARDS trial

Prone Positioning Saves Lives in Severe ARDS Patients: NEJM It’s long been known that positioning patients with ARDS on mechanical ventilation face-down (prone) improves their oxygenation. (There are various theories why prone positioning helps, such as by reducing ARDS’s injurious heterogeneous alveolar overdistension.) The improved oxygen levels have never translated into improved outcomes in ARDS [… read more]

Apr 252013
 
Pulse oximetry as time machine: Lag times confuse doctors, complicate intubations (EMCrit)

image: wikimedia Pulse Oximetry: The 30-Second Time Machine Why does it seem to take so long to re-oxygenate your crashing patient? Because your pulse oximeter is lying to you, no matter how good it is. Telescopes show us how a star looked millions or billions of years ago; pulse oximeters create a similar, though tiny [… read more]

Apr 112013
 
Obesity may improve survival in ARDS, but with renal failure

In ARDS, Obesity May Protect Life (But Not Kidneys) by Blair Westerly, MD Obesity is an epidemic and common in intensive care units in the United States.  Furthermore, while acute kidney injury (AKI) is also common in critically ill patients, obese patients carry additional risk for AKI because of increased baseline comorbidities. Both obesity and [… read more]

Mar 162013
 
High frequency oscillation ventilation fails as 1st-line treatment for ARDS (RCTs)

(image: Wikipedia) High-Frequency Oscillatory Ventilation (HFOV) for ARDS Two Randomized Trials: Early HFOV Doesn’t Help, May Harm High-frequency oscillatory ventilation (HFOV) has been proposed as a first-line therapy for acute respiratory distress syndrome (ARDS). By delivering 3-15 breaths per second of tiny tidal volumes (~70 mL), HFOV has appeal as the “ultimate” lung protective ventilator [… read more]

Jan 182013
 
Come One, Come All – Low tidal volumes improve outcomes

Low Tidal Volumes Improve Outcomes in Non-ARDS Patients Since the landmark ARDSnet trial of low tidal volume ventilation published in the NEJM in 2000, protecting the injured lung with low tidal volumes has been widely adopted. In case you missed it, that trial showed that low tidal volume ventilation (6 ml/kg IBW) improved mortality from [… read more]

Dec 312012
 
Adherence with low tidal volumes for ARDS is poor at top centers; reduces survival

(image: Wikipedia) Anyone with the keys to a ventilator knows, or should, that low tidal volume ventilation (~6 mL/kg ideal body weight) for patients with ARDS can be lifesaving: as many as one in 11 people with ARDS treated by low tidal volume ventilation may have their lives saved or extended while in the hospital. [… read more]

Dec 312012
 
In ARDS, women and short people get higher, potentially deadly tidal volumes

In most areas of life, it helps to be tall, and needing treatment for ARDS further proves the rule. Tall people are less likely to get harmful lung-distending tidal volumes during mechanical ventilation, simply by virtue of having bigger lungs. It’s bad enough that we intensivists might discriminate against the under-six-feet crowd (of which I [… read more]

Dec 302012
 
Meet the New ARDS: Expert panel announces new definition, severity classes

(image: Wikipedia) A consensus panel led by V. Marco Ranieri, Gordon Rubenfeld, Arthur Slutsky et al announced a new definition and severity classfication system for acute respiratory distress syndrome (ARDS) that aims to simplify the diagnosis and better prognosticate outcomes from the life-threatening pulmonary illness. The proposed “Berlin definition” predicted mortality ever-so-slightly better than the [… read more]

Dec 222012
 
Trophic feeding equal to full enteric feeding in acute lung injury (EDEN trial)

Where should we set the dial for caloric delivery to our patients with acute lung injury and acute respiratory distress syndrome (ARDS)? Weak observational trials suggest low caloric intake might be associated with poor outcomes [ref1, 2]. On the other hand, other observational data suggests just the opposite: restricting calories early on may reduce ventilator [… read more]