Acute lung injury & critical care update for 2010: Vadasz I, Sznajder J, AJRCCM 2011;183:1147-1152. ARDS review. Critical care review.
May 152011
May 152011
Prone positioning improves oxygenation in ARDS patients without improving outcome. Recruitment maneuvers do too. Rival et al prospectively tested the effects of both strategies together in 16 ARDS patients. Two extended sighs of 45 cm H2O in pressure control mode while lying prone improved PaO2/FiO2 from 98 to 166 mm Hg, without obvious adverse (or positive) effects. Critical [… read more]
May 022011
Databases suggest that 60-70% of patients with severe respiratory failure due to H1N1 received steroids. Brun-Buisson et al looked back at a French registry including 208 patients with H1N1 and ARDS, 83 of whom received steroids. They found a hazard ratio of 2.4 for death associated with steroid administration, rising to 2.8 after applying their propensity scoring [… read more]
Apr 272011
Those patients with severe acute lung injury due to pneumonia or aspiration who received the rSP-C surfactant product did no better on important outcomes (28-day survival, need for ventilation, organ-failure-free days) than those receiving usual care, report Spragg et al.(n=843). AJRCCM 2011;183:1055-1061.
Apr 232011
In 1998, Dr. Cheryl Misak survived organ failure in the ICU; this month, she shares her story of a long and difficult recovery from debility. Although highly educated and motivated, and in top pre-admission physical shape, her struggle was formidable. Twelve years later, are we doing any better at adequately informing and preparing patients like [… read more]
Feb 162011
ARDS and multi-organ failure: Curr Opin Crit Care 2011;17:1-6. Hemodynamic monitoring of ventilated patients: Ibid, pp. 36-42 The ‘ABCDE’ bundle for critical care: Ibid, pp. 43-49. Managing severely hypoxemic patients: Ibid.
Jan 242008
Meade MO et al. (Lung open ventilation study investigators) Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2008; 299:637-45. Higher PEEP provided no benefit in 28-day mortality (28 vs 32%, p = 0.2), although it reduced refractory hypoxia (~5% [… read more]
Aug 242004
Brower RG et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004;351:327-36. Randomized trial among 549 patients with ARDS/ALI conducted by NHLBI/ARDSNet. Compared high and low PEEP strategies, and found no significant difference in mortality, ventilator-free days, ICU-free days, or organ failure-free days between [… read more]
May 242003
Herridge MS et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003; 348:683-93. Non-pulmonary problems are usually dominant in impairment of ARDS survivors. Low exercise tolerance, fatigue, and weakness are common a year after discharge. Pulmonary function tests usually normalized, other than a diffusion impairment. At 12 months, only 6% [… read more]
Jul 242000
ARDS Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for ALI and ARDS. N Engl J Med 2000;342:1301-8. The ARMA study found the use of low (6 ml/kg predicted weight) rather than “standard” (12 ml/kg predicted weight) tidal volumes reduced mortality from 40 to 30%. This paper established the standard of low [… read more]
Apr 241999
Rubenfeld GD, Caldwell E, Granton J, et al. Interobserver variability in applying a radiographic definition for ARDS. Chest 1999;116:1347-53. Interobserver agreement was only moderate for diagnosing ARDS among 21 experts using consensus radiographic criteria.
Oct 241995
Hudson LD et al. Clinical risks for development of ARDS. Am J Respir Crit Care Med 1995;151:293-301. Incidence of ARDS in patients with various risk factors. Showed that ARDS develops within 48 to 72 hours of the time clinical risk is identified in the vast majority of patients.