1 / 30

Protective Lung Strategy Mazen Kherallah, MD, FCCP

Protective Lung Strategy Mazen Kherallah, MD, FCCP. Conventional Vs Protective. Actuarial 28-Day Survival among 53 Patients with the Acute Respiratory Distress Syndrome Assigned to Protective or Conventional Mechanical Ventilation. Amato M et al. N Engl J Med 1998;338:347-354.

adara
Download Presentation

Protective Lung Strategy Mazen Kherallah, MD, FCCP

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Protective Lung StrategyMazen Kherallah, MD, FCCP

  2. Conventional Vs Protective

  3. Actuarial 28-Day Survival among 53 Patients with the Acute Respiratory Distress Syndrome Assigned to Protective or Conventional Mechanical Ventilation Amato M et al. N Engl J Med 1998;338:347-354

  4. VENTILATION WITH LOWER TIDAL VOLUMES AS COMPARED WITH TRADITIONAL TIDAL VOLUMES FOR ACUTE LUNG INJURY AND THE ACUTE RESPIRATORY DISTRESS SYNDROME .ARDSnet N Engl J Med 2000;342:1301-1308

  5. NIH ARDS Network TrialMechanical Ventilation in ARDS P = 0.007 ARDSnet N Engl J Med 2000;342:1301-1308

  6. SUMMARY OF RANDOMIZED CONTROLLED TRIALS OF VOLUME- ANDPRESSURE-LIMITED MECHANICAL VENTILATION Hager DN et al . Am J RespirCrit Care Med 172:1241–1245

  7. High PEEP Low Tidal Volume

  8. A high PEEP-low tidal volume ventilatory strategy improves outcome in persistent ARDS Villar et al. 2006 May;34(5):1311-8

  9. LOVS StudyLung Open Ventilation Study

  10. Results of 3 Trials of Aggressive vs Conservative PEEP

  11. Prone Position

  12. Kaplan-Meier Estimates of Survival at Six Months Gattinoni L et al. N Engl J Med 2001;345:568-573

  13. Changes in Respiratory Variables during the 10-Day Treatment Period Gattinoni L et al. N Engl J Med 2001;345:568-573

  14. Incidence of Complications Gattinoni L et al. N Engl J Med 2001;345:568-573

  15. A Multicenter Trial of Prolonged Prone Ventilation in Severe Acute Respiratory Distress Syndrome mean of 17 h/d for a mean of 10 d. Mancebo J, et al.Am J Respir Crit Care Med 173:1233–1239

  16. Semirecumbent Position

  17. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomized trial 86 patients: 95% CI for difference 10.0-42.0, p=0.003). .Drakulovic MB 1999 Nov 27;354(9193):1851-8.

  18. Noninvasive Ventilation in ALI/ARDS with mild/moderate Hypoxemic Respiratory Failure

  19. The Ratio of the Partial Pressure of Arterial Oxygen to the Fraction of Inspired Oxygen (PaO2:FiO2) at Base Line and after One Hour of Mechanical Ventilation in Patients with Acute Respiratory Failure in the Noninvasive-Ventilation and Conventional-Ventilation Groups Antonelli M et al. N Engl J Med 1998;339:429-435

  20. Serious Complications Antonelli M et al. N Engl J Med 1998;339:429-435

  21. Protocolized Weaning with Spontaneous Breathing Trials

  22. Effect on the Duration of Mechanical Ventilation of Identifying Patients Capable of Breathing Spontaneously Ely E et al. N Engl J Med 1996;335:1864-1869

  23. Comparison of Outcomes between Study Groups Ely E et al. N Engl J Med 1996;335:1864-1869

  24. No Routine Use of PAC

  25. Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury Volume 354;21:2213-2224 May 25, 2006

  26. Catheter-Related Complications

  27. Conservative Fluid Strategy in Patient with no Tissue Hypoperfusion

  28. Comparison of Two Fluid-Management Strategies in Acute Lung Injury The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network N Engl J Med 2006;354:2564-2575

  29. Probability of Survival to Hospital Discharge and of Breathing without Assistance during the First 60 Days after Randomization The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network N Engl J Med 2006;354:2564-2575

  30. Ventilatory Support • Target a tidal volume of 6ml/kg (predicted) body weight in patients with ALI/ARDS. (1B) • Target an initial upper limit plateau pressure ≤30 cmH2O. Consider chest wall compliance when assessing plateau pressure. (1C) • Allow PaCO2 to increase above normal, if needed to minimize plateau pressures and tidal volumes. (1C) • Positive end expiratory pressure (PEEP) should be set to avoid extensive lung collapse at end expiration. (1C) • Consider using the prone position for ARDS patients requiring potentially injurious levels of FiO2 or plateau pressure, provided they are not put at risk from positional changes. (2C) • Maintain mechanically ventilated patients in a semi-recumbent position (head of the bed raised to 45 ◦) unless contraindicated (1B), between 30◦–45◦ (2C). • Non invasive ventilation may be considered in the minority of ALI/ARDS patients with mild-moderate hypoxemic respiratory failure. • Use a weaning protocol and a spontaneous breathing trial (SBT) regularly to evaluate the potential for discontinuing mechanical ventilation. (1A) • Do not use a PAC for the routine monitoring of patients with ALI/ARDS. (1A)

More Related