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The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia

PURPOSE: 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. METHODS AND...

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Autores principales: Bein, Thomas, Grasso, Salvatore, Moerer, Onnen, Quintel, Michael, Guerin, Claude, Deja, Maria, Brondani, Anita, Mehta, Sangeeta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828494/
https://www.ncbi.nlm.nih.gov/pubmed/27040102
http://dx.doi.org/10.1007/s00134-016-4325-4
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author Bein, Thomas
Grasso, Salvatore
Moerer, Onnen
Quintel, Michael
Guerin, Claude
Deja, Maria
Brondani, Anita
Mehta, Sangeeta
author_facet Bein, Thomas
Grasso, Salvatore
Moerer, Onnen
Quintel, Michael
Guerin, Claude
Deja, Maria
Brondani, Anita
Mehta, Sangeeta
author_sort Bein, Thomas
collection PubMed
description PURPOSE: 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. METHODS AND RESULTS: 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 PaO(2)/FIO(2) < 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 (≤ 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 ≤ 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. CONCLUSIONS: A specific standard of care is required for the management of severe ARDS with refractory hypoxemia.
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spelling pubmed-48284942016-04-21 The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia Bein, Thomas Grasso, Salvatore Moerer, Onnen Quintel, Michael Guerin, Claude Deja, Maria Brondani, Anita Mehta, Sangeeta Intensive Care Med Review PURPOSE: 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. METHODS AND RESULTS: 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 PaO(2)/FIO(2) < 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 (≤ 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 ≤ 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. CONCLUSIONS: A specific standard of care is required for the management of severe ARDS with refractory hypoxemia. Springer Berlin Heidelberg 2016-04-04 2016 /pmc/articles/PMC4828494/ /pubmed/27040102 http://dx.doi.org/10.1007/s00134-016-4325-4 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Review
Bein, Thomas
Grasso, Salvatore
Moerer, Onnen
Quintel, Michael
Guerin, Claude
Deja, Maria
Brondani, Anita
Mehta, Sangeeta
The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia
title The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia
title_full The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia
title_fullStr The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia
title_full_unstemmed The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia
title_short The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia
title_sort standard of care of patients with ards: ventilatory settings and rescue therapies for refractory hypoxemia
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828494/
https://www.ncbi.nlm.nih.gov/pubmed/27040102
http://dx.doi.org/10.1007/s00134-016-4325-4
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