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]
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]
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]
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]
Ultrasound in the ICU: Case 1 Discussion Go Back to Ultrasound Case 1 Ultrasound Case 1 Answer: Hypovolemia. Hypotension may be caused by diverse pathophysiologic states that are hard to differentiate by clinical exam. Bedside ultrasound can provide immediate visual information that can help to rapidly make diagnoses of life-threatening conditions, without dependence on radiology [… read more]
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.