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proning and ards: physiology and rational

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2 papers 0 to 25 followers
By Jason Mann No BS pulmonary critical care fellow
Colin K Grissom, Eliotte L Hirshberg, Justin B Dickerson, Samuel M Brown, Michael J Lanspa, Kathleen D Liu, David Schoenfeld, Mark Tidswell, R Duncan Hite, Peter Rock, Russell R Miller, Alan H Morris
OBJECTIVES: In the Fluid and Catheter Treatment Trial (FACTT) of the National Institutes of Health Acute Respiratory Distress Syndrome Network, a conservative fluid protocol (FACTT Conservative) resulted in a lower cumulative fluid balance and better outcomes than a liberal fluid protocol (FACTT Liberal). Subsequent Acute Respiratory Distress Syndrome Network studies used a simplified conservative fluid protocol (FACTT Lite). The objective of this study was to compare the performance of FACTT Lite, FACTT Conservative, and FACTT Liberal protocols...
February 2015: Critical Care Medicine
Luciano Gattinoni, Paolo Taccone, Eleonora Carlesso, John J Marini
In the prone position, computed tomography scan densities redistribute from dorsal to ventral as the dorsal region tends to reexpand while the ventral zone tends to collapse. Although gravitational influence is similar in both positions, dorsal recruitment usually prevails over ventral derecruitment, because of the need for the lung and its confining chest wall to conform to the same volume. The final result of proning is that the overall lung inflation is more homogeneous from dorsal to ventral than in the supine position, with more homogeneously distributed stress and strain...
December 1, 2013: American Journal of Respiratory and Critical Care Medicine
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