The twitter feed can be found here
The physiology of ARF
Consideration of oxygenation and ventilation as separate components
Effects of MV
- Increase VA/Q
- Decrease elastic workload
- Decrease resistive workload
Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment (2018) – https://www.ncbi.nlm.nih.gov/pubmed/29466596
Comparison of definitions – https://www.ncbi.nlm.nih.gov/pubmed/23370917
Phases of ARDS
The principles of controlled mechanical ventilation
Ventilator detects flow and pressure (sensors)
P(open alveolar) = P(resistance of the airway) + P(elastic resistance of the alveoli)
Modes – volume vs pressure (hybrid = pressure regulated volume controlled ventilation)
Volume controlled ventilation
Pressure drop between peak and plateau pressure is reflective of airway resistance
Pressure controlled ventilation
Which mode of ventilation is ‘better’ does not matter as there is no difference in plateau pressure BUT could/should square vs decelerated flow (may contribute to a difference)
Hybrid modes may have share the benefits of both (constant Vt + decelerated flow)
EXCELLENT RESOUCE – https://www.youtube.com/youvent
The correct strategy for ARDS
The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828494/
Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis – https://www.ncbi.nlm.nih.gov/pubmed/20197533
Open Lung Approach for the Acute Respiratory Distress Syndrome: A Pilot, Randomized Controlled Trial. https://www.ncbi.nlm.nih.gov/pubmed/26672923
There was a discussion on Stress/Strain which I admit I don’t consider regularly…..
Support therapy in ARDS
Aetiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicentre study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476531/
Daily Sedation Interruption in Mechanically Ventilated Critically Ill Patients Cared for With a Sedation Protocol: A Randomized Controlled Trial: https://jamanetwork.com/journals/jama/fullarticle/1380160
Sedation summary
- Keep pt awake/light
- If deep sedation required – avoid benzos
- Protocol-based
Volatile sedation in the intensive care unit: A systematic review and meta-analysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728884/
Proning – http://www.nejm.org/doi/pdf/10.1056/NEJMoa1214103
Steroids and other adjuvant therapies
Effect of Prolonged Methylprednisolone Therapy in Unresolving Acute Respiratory Distress Syndrome: A Randomized Controlled Trial: https://jamanetwork.com/journals/jama/fullarticle/187709
Exploring the heterogeneity of effects of corticosteroids on acute respiratory distress syndrome: a systematic review and meta-analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056095/
Prolonged glucocorticoid treatment is associated with improved ARDS outcomes: analysis of individual patients’ data from four randomized trials and trial-level meta-analysis of the updated literature http://icmjournal.esicm.org/journals/abstract.html?v=0&j=134&i=0&a=4095_10.1007_s00134-015-4095-4&doi=
Salbutamol: Inhalation therapies in acute respiratory distress syndrome – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537120/
Surfactant: Exogenous natural surfactant for treatment of acute lung injury and the acute respiratory distress syndrome. https://www.ncbi.nlm.nih.gov/pubmed/19713451
NAC: Effects of N-acetylcysteine treatment in acute respiratory distress syndrome: A meta-analysis –https://www.ncbi.nlm.nih.gov/m/pubmed/28928799/
New(ish)
- Neutrophil esterase inhibitors
- Granulocyte macrophage CSF
- Interferon
- Stem cells
ARDS: challenges in patient care and frontiers in research: http://err.ersjournals.com/content/27/147/170107