Menk, Mario and Estenssoro, Elisa and Sahetya, Sarina K. and Neto, Ary Serpa and Sinha, Pratik and Slutsky, Arthur S. and Summers, Charlotte and Yoshida, Takeshi and Bein, Thomas and Ferguson, Niall D. (2020) Current and evolving standards of care for patients with ARDS. INTENSIVE CARE MEDICINE, 46 (12). pp. 2157-2167. ISSN 0342-4642, 1432-1238
Full text not available from this repository. (Request a copy)Abstract
Care for patients with acute respiratory distress syndrome (ARDS) has changed considerably over the 50 years since its original description. Indeed, standards of care continue to evolve as does how this clinical entity is defined and how patients are grouped and treated in clinical practice. In this narrative review we discuss current standards - treatments that have a solid evidence base and are well established as targets for usual care - and also evolving standards - treatments that have promise and may become widely adopted in the future. We focus on three broad domains of ventilatory management, ventilation adjuncts, and pharmacotherapy. Current standards for ventilatory management include limitation of tidal volume and airway pressure and standard approaches to setting PEEP, while evolving standards might focus on limitation of driving pressure or mechanical power, individual titration of PEEP, and monitoring efforts during spontaneous breathing. Current standards in ventilation adjuncts include prone positioning in moderate-severe ARDS and veno-venous extracorporeal life support after prone positioning in patients with severe hypoxemia or who are difficult to ventilate. Pharmacotherapy current standards include corticosteroids for patients with ARDS due to COVID-19 and employing a conservative fluid strategy for patients not in shock; evolving standards may include steroids for ARDS not related to COVID-19, or specific biological agents being tested in appropriate sub-phenotypes of ARDS. While much progress has been made, certainly significant work remains to be done and we look forward to these future developments.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | RESPIRATORY-DISTRESS-SYNDROME; END-EXPIRATORY PRESSURE; EXTRACORPOREAL MEMBRANE-OXYGENATION; ACUTE LUNG INJURY; HIGH-FREQUENCY OSCILLATION; INHALED NITRIC-OXIDE; MECHANICAL VENTILATION; FLUID-MANAGEMENT; AIRWAY PRESSURE; MORTALITY; Acute respiratory distress syndrome; Mechanical ventilation; Prone position; Extra-corporeal life support; Acute respiratory failure |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie |
| Depositing User: | Petra Gürster |
| Date Deposited: | 21 Apr 2021 06:38 |
| Last Modified: | 21 Apr 2021 06:38 |
| URI: | https://pred.uni-regensburg.de/id/eprint/43404 |
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