Preventing Lung injury in ARDS- Ranieri (Keynote 25th Sept 2017) #LIVES2017

Claudio Ranieri starts us off with a discussion and reminder about the importance of transpulmonary pressure- elegantly described in this excellent NEJM paper http://www.nejm.org/doi/full/10.1056/NEJMra1208707?af%3DR%26rss%3DcurrentIssue …

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Titrating ventilation to transpulmonary pressure may have a mortality benefit, as seen in this H1N1 series ncbi.nlm.nih.gov/m/pubmed/22323…

Spontaneous breathing isn’t always protective- extreme negative intrathoracic pressures can cause large increases in transpulmonary pressure ncbi.nlm.nih.gov/pubmed/10593817

Targeting low transpulmonary pressures isn’t just of benefit to those with ARDS- surgical patients (nejm.org/doi/full/10.10…) and organ donors (ncbi.nlm.nih.gov/pubmed/21156950) have both seen benefits from a lung protective approach.

There is some evidence that ventilator induced lung injury causes direct neurological damage (ncbi.nlm.nih.gov/pubmed/23962032)- could this be directly contributing to the delirium we see?

 

FURTHER READING

Try Jon-Emile Kenny’s excellent pulmonary physiology series here pulmccm.org/main/2017/unca…

 

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