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Ewan C Goligher, Brian P Kavanagh, Gordon D Rubenfeld, Neill K J Adhikari, Ruxandra Pinto, Eddy Fan, Laurent J Brochard, John T Granton, Alain Mercat, Jean-Christophe Marie Richard, Jean-Marie Chretien, Graham L Jones, Deborah J Cook, Thomas E Stewart, Arthur S Slutsky, Maureen O Meade, Niall D Ferguson
RATIONALE: Previous trials of higher positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) failed to demonstrate mortality benefit, possibly because of differences in lung recruitability among patients with ARDS. OBJECTIVES: To determine whether the physiological response to increased PEEP is associated with mortality. METHODS: In a secondary analysis of the Lung Open Ventilation Study (LOVS, n = 983), we examined the relationship between the initial response to changes in PEEP after randomization and mortality...
July 1, 2014: American Journal of Respiratory and Critical Care Medicine
Eric L Scholten, Jeremy R Beitler, G Kim Prisk, Atul Malhotra
Prone positioning was first proposed in the 1970s as a method to improve gas exchange in ARDS. Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research. This work elucidated the physiological mechanisms underlying changes in gas exchange and respiratory mechanics with prone ventilation. However, translating physiological improvements into a clinical benefit has proved challenging; several contemporary trials showed no major clinical benefits with prone positioning...
January 2017: Chest
Kenneth P Steinberg, Leonard D Hudson, Richard B Goodman, Catherine Lee Hough, Paul N Lanken, Robert Hyzy, B Taylor Thompson, Marek Ancukiewicz
BACKGROUND: Persistent acute respiratory distress syndrome (ARDS) is characterized by excessive fibroproliferation, ongoing inflammation, prolonged mechanical ventilation, and a substantial risk of death. Because previous reports suggested that corticosteroids may improve survival, we performed a multicenter, randomized controlled trial of corticosteroids in patients with persistent ARDS. METHODS: We randomly assigned 180 patients with ARDS of at least seven days' duration to receive either methylprednisolone or placebo in a double-blind fashion...
April 20, 2006: New England Journal of Medicine
Roy G Brower, Paul N Lanken, Neil MacIntyre, Michael A Matthay, Alan Morris, Marek Ancukiewicz, David Schoenfeld, B Taylor Thompson
BACKGROUND: Most patients requiring mechanical ventilation for acute lung injury and the acute respiratory distress syndrome (ARDS) receive positive end-expiratory pressure (PEEP) of 5 to 12 cm of water. Higher PEEP levels may improve oxygenation and reduce ventilator-induced lung injury but may also cause circulatory depression and lung injury from overdistention. We conducted this trial to compare the effects of higher and lower PEEP levels on clinical outcomes in these patients. METHODS: We randomly assigned 549 patients with acute lung injury and ARDS to receive mechanical ventilation with either lower or higher PEEP levels, which were set according to different tables of predetermined combinations of PEEP and fraction of inspired oxygen...
July 22, 2004: New England Journal of Medicine
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