Bein, Thomas and Grasso, Salvatore and Moerer, Onnen and Quintel, Michael and Guerin, Claude and Deja, Maria and Brondani, Anita and Mehta, Sangeeta (2016) The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia. INTENSIVE CARE MEDICINE, 42 (5). pp. 699-711. ISSN 0342-4642, 1432-1238
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Severe ARDS is often associated with refractory hypoxemia, and early identification and treatment of hypoxemia is mandatory. For the management of severe ARDS ventilator settings, positioning therapy, infection control, and supportive measures are essential to improve survival. A precise definition of life-threating hypoxemia is not identified. Typical clinical determinations are: arterial partial pressure of oxygen < 60 mmHg and/or arterial oxygenation < 88 % and/or the ratio of PaO2/FIO2 < 100. For mechanical ventilation specific settings are recommended: limitation of tidal volume (6 ml/kg predicted body weight), adequate high PEEP (> 12 cmH(2)O), a recruitment manoeuvre in special situations, and a 'balanced' respiratory rate (20-30/min). Individual bedside methods to guide PEEP/recruitment (e.g., transpulmonary pressure) are not (yet) available. Prone positioning [early (a parts per thousand currency sign 48 hrs after onset of severe ARDS) and prolonged (repetition of 16-hr-sessions)] improves survival. An advanced infection management/control includes early diagnosis of bacterial, atypical, viral and fungal specimen (blood culture, bronchoalveolar lavage), and of infection sources by CT scan, followed by administration of broad-spectrum anti-infectives. Neuromuscular blockage (Cisatracurium a parts per thousand currency sign 48 hrs after onset of ARDS), as well as an adequate sedation strategy (score guided) is an important supportive therapy. A negative fluid balance is associated with improved lung function and the use of hemofiltration might be indicated for specific indications. A specific standard of care is required for the management of severe ARDS with refractory hypoxemia.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | RESPIRATORY-DISTRESS-SYNDROME; RANDOMIZED CONTROLLED-TRIAL; ACUTE LUNG INJURY; END-EXPIRATORY PRESSURE; CRITICALLY-ILL PATIENTS; NEUROMUSCULAR BLOCKING-AGENTS; INHALED NITRIC-OXIDE; MECHANICAL VENTILATION; PRONE POSITION; RECRUITMENT MANEUVERS; Acute respiratory distress syndrome; Refractory hypoxemia; Ventilatory settings; Prone positioning; Infection management; Neuromuscular blockade |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie |
| Depositing User: | Petra Gürster |
| Date Deposited: | 01 Sep 2020 08:25 |
| Last Modified: | 01 Sep 2020 08:25 |
| URI: | https://pred.uni-regensburg.de/id/eprint/3037 |
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