Journal ArticleDOI
High-frequency oscillation in early acute respiratory distress syndrome.
Niall D. Ferguson,Deborah J. Cook,Gordon H. Guyatt,Sangeeta Mehta,Peggy Austin,Qi Zhou,Andrea Matte,Stephen D. Walter,Francois Lamontagne,John Granton,Yaseen M. Arabi,Alejandro C. Arroliga,Thomas E. Stewart,Arthur S. Slutsky,Maureen O. Meade +14 more
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TLDR
In adults with moderate-to-severe ARDS, early application of HFOV, as compared with a ventilation strategy of low tidal volume and high positive end-expiratory pressure, does not reduce, and may increase, in-hospital mortality.Abstract:
Background Previous trials suggesting that high-frequency oscillatory ventilation (HFOV) reduced mortality among adults with the acute respiratory distress syndrome (ARDS) were limited by the use of outdated comparator ventilation strategies and small sample sizes. Methods In a multicenter, randomized, controlled trial conducted at 39 intensive care units in five countries, we randomly assigned adults with new-onset, moderate-to-severe ARDS to HFOV targeting lung recruitment or to a control ventilation strategy targeting lung recruitment with the use of low tidal volumes and high positive end-expiratory pressure. The primary outcome was the rate of in-hospital death from any cause. Results On the recommendation of the data monitoring committee, we stopped the trial after 548 of a planned 1200 patients had undergone randomization. The two study groups were well matched at baseline. The HFOV group underwent HFOV for a median of 3 days (interquartile range, 2 to 8); in addition, 34 of 273 patients (12%) in the control group received HFOV for refractory hypoxemia. In-hospital mortality was 47% in the HFOV group, as compared with 35% in the control group (relative risk of death with HFOV, 1.33; 95% confidence interval, 1.09 to 1.64; P = 0.005). This finding was independent of baseline abnormalities in oxygenation or respiratory compliance. Patients in the HFOV group received higher doses of midazolam than did patients in the control group (199 mg per day [interquartile range, 100 to 382] vs. 141 mg per day [interquartile range, 68 to 240], P<0.001), and more patients in the HFOV group than in the control group received neuromuscular blockers (83% vs. 68%, P<0.001). In addition, more patients in the HFOV group received vasoactive drugs (91% vs. 84%, P = 0.01) and received them for a longer period than did patients in the control group (5 days vs. 3 days, P = 0.01). Conclusions In adults with moderate-to-severe ARDS, early application of HFOV, as compared with a ventilation strategy of low tidal volume and high positive end-expiratory pressure, does not reduce, and may increase, in-hospital mortality. (Funded by the Canadian Institutes of Health Research; Current Controlled Trials numbers, ISRCTN42992782 and ISRCTN87124254, and ClinicalTrials.gov numbers, NCT00474656 and NCT01506401.)read more
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Journal ArticleDOI
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Andrew Rhodes,Laura Evans,Waleed Alhazzani,Mitchell M. Levy,Massimo Antonelli,Ricard Ferrer,Anand Kumar,Jonathan E. Sevransky,Charles L. Sprung,Mark E. Nunnally,Bram Rochwerg,Gordon D. Rubenfeld,Derek C. Angus,Djillali Annane,Richard Beale,Geoffrey J. Bellinghan,Gordon R. Bernard,Jean Daniel Chiche,Craig M. Coopersmith,Daniel De Backer,Craig French,Seitaro Fujishima,Herwig Gerlach,Jorge Hidalgo,Steven M. Hollenberg,Alan E. Jones,Dilip R. Karnad,Ruth M. Kleinpell,Younsuck Koh,Thiago Lisboa,Flávia Ribeiro Machado,John J. Marini,John C. Marshall,John E. Mazuski,Lauralyn McIntyre,Anthony S. McLean,Sangeeta Mehta,Rui Moreno,John Myburgh,Paolo Navalesi,Osamu Nishida,Tiffany M. Osborn,Anders Perner,Colleen M. Plunkett,Marco Ranieri,Christa A. Schorr,Maureen A. Seckel,Christopher W. Seymour,Lisa Shieh,Khalid A. Shukri,Steven Q. Simpson,Mervyn Singer,B. Taylor Thompson,Sean R. Townsend,Thomas Van der Poll,Jean Louis Vincent,W. Joost Wiersinga,Janice L. Zimmerman,R. Phillip Dellinger +58 more
TL;DR: Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.
Journal ArticleDOI
Prone Positioning in Severe Acute Respiratory Distress Syndrome
Claude Guérin,Jean Reignier,Jean-Christophe Richard,Pascal Beuret,Arnaud Gacouin,Thierry Boulain,Emmanuelle Mercier,Michel Badet,Alain Mercat,Olivier Baudin,Marc Clavel,Delphine Chatellier,Samir Jaber,Sylvène Rosselli,Jordi Mancebo,Michel Sirodot,Gilles Hilbert,Christian Bengler,Jack Richecoeur,Marc Gainnier,Frédérique Bayle,Gael Bourdin,Véronique Leray,Raphaële Girard,Loredana Baboi,Louis Ayzac +25 more
TL;DR: In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality.
Journal ArticleDOI
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.
Andrew Rhodes,Laura Evans,Waleed Alhazzani,Mitchell M. Levy,Massimo Antonelli,Ricard Ferrer,Anand Kumar,Jonathan E. Sevransky,Charles L. Sprung,Mark E. Nunnally,Bram Rochwerg,Gordon D. Rubenfeld,Derek C. Angus,Djillali Annane,Richard Beale,Geoffrey J. Bellinghan,Gordon R. Bernard,Jean Daniel Chiche,Craig M. Coopersmith,Daniel De Backer,Craig French,Seitaro Fujishima,Herwig Gerlach,Jorge Hidalgo,Steven M. Hollenberg,Alan E. Jones,Dilip R. Karnad,Ruth M. Kleinpell,Younsuck Koh,Thiago Lisboa,Flávia Ribeiro Machado,John J. Marini,John C. Marshall,John E. Mazuski,Lauralyn McIntyre,Anthony S. McLean,Sangeeta Mehta,Rui Moreno,John Myburgh,Paolo Navalesi,Osamu Nishida,Tiffany M. Osborn,Anders Perner,Colleen M. Plunkett,Marco Ranieri,Christa A. Schorr,Maureen A. Seckel,Christopher W. Seymour,Lisa Shieh,Khalid A. Shukri,Steven Q. Simpson,Mervyn Singer,B. Taylor Thompson,Sean R. Townsend,Thomas Van der Poll,Jean Louis Vincent,W. Joost Wiersinga,Janice L. Zimmerman,R. Phillip Dellinger +58 more
TL;DR: A consensus committee of 55 international experts representing 25 international organizations was assembled at key international meetings (forSurviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012 as discussed by the authors ).
Journal ArticleDOI
Ventilator-Induced Lung Injury
TL;DR: The probable causes of mechanical ventilation injury and ways to prevent it are reviewed.
Journal ArticleDOI
An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome
Eddy Fan,Lorenzo Del Sorbo,Ewan C. Goligher,Carol L. Hodgson,Laveena Munshi,Allan J. Walkey,Neill K. J. Adhikari,Marcelo B. P. Amato,Richard D. Branson,Roy G. Brower,Niall D. Ferguson,Ognjen Gajic,Luciano Gattinoni,Dean R. Hess,Jordi Mancebo,Maureen O. Meade,Daniel F. McAuley,Antonio Pesenti,V. Marco Ranieri,Gordon D. Rubenfeld,Eileen Rubin,Maureen A. Seckel,Arthur S. Slutsky,Daniel Talmor,B. Taylor Thompson,Hannah Wunsch,Elizabeth Uleryk,Jan Brozek,Laurent Brochard +28 more
TL;DR: Clinicians managing patients with ARDS should personalize decisions for their patients, particularly regarding the conditional recommendations in this guideline, which is strong for mechanical ventilation using lower tidal volumes and lower inspiratory pressures.
References
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Journal ArticleDOI
APACHE II: a severity of disease classification system.
TL;DR: The form and validation results of APACHE II, a severity of disease classification system that uses a point score based upon initial values of 12 routine physiologic measurements, age, and previous health status, are presented.
Journal ArticleDOI
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.
Roy G. Brower,Michael A. Matthay,Alan H. Morris,David A. Schoenfeld,B. Taylor Thompson,Arthur P. Wheeler +5 more
TL;DR: In patients with acute lung injury and the acute respiratory distress syndrome, mechanical ventilation with a lower tidal volume than is traditionally used results in decreased mortality and increases the number of days without ventilator use.
Journal ArticleDOI
Acute respiratory distress syndrome: the Berlin Definition.
Ards Definition Task Force,V. Marco Ranieri,Gordon D. Rubenfeld,B. Taylor Thompson,Niall D. Ferguson,Ellen Caldwell,Eddy Fan,Luigi Camporota,Luigi Camporota,Arthur S. Slutsky +9 more
TL;DR: The updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition and may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.
Journal ArticleDOI
Incidence and Outcomes of Acute Lung Injury
Gordon D. Rubenfeld,Ellen Caldwell,Eve Peabody,Jim Weaver,Diane P. Martin,Margaret J. Neff,Eric J. Stern,Leonard D. Hudson +7 more
TL;DR: It is estimated that each year in the United States there are 190,600 cases of acute lung injury, which are associated with 74,500 deaths and 3.6 million hospital days, considerably higher than previous reports have suggested.
Journal ArticleDOI
APACHE II--a severity of disease classification system.
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