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By Carlos David emergency phisician
Thomas Bein, Salvatore Grasso, Onnen Moerer, Michael Quintel, Claude Guerin, Maria Deja, Anita Brondani, Sangeeta Mehta
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 PaO2/FIO2 < 100...
May 2016: Intensive Care Medicine
Matthew W Semler, Arthur P Wheeler, B Taylor Thompson, Gordon R Bernard, Herbert P Wiedemann, Todd W Rice
OBJECTIVES: In acute respiratory distress syndrome, conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients' initial central venous pressure. We hypothesized that initial central venous pressure would modify the effect of fluid management on outcomes. DESIGN: Retrospective analysis of the Fluid and Catheter Treatment Trial, a multicenter randomized trial comparing conservative with liberal fluid management in acute respiratory distress syndrome...
April 2016: Critical Care Medicine
Raquel S Santos, Pedro L Silva, Paolo Pelosi, Patricia Rm Rocco
Acute respiratory distress syndrome (ARDS) represents a serious problem in critically ill patients and is associated with in-hospital mortality rates of 33%-52%. Recruitment maneuvers (RMs) are a simple, low-cost, feasible intervention that can be performed at the bedside in patients with ARDS. RMs are characterized by the application of airway pressure to increase transpulmonary pressure transiently. Once non-aerated lung units are reopened, improvements are observed in respiratory system mechanics, alveolar reaeration on computed tomography, and improvements in gas exchange (functional recruitment)...
November 4, 2015: World Journal of Critical Care Medicine
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