Journal ArticleDOI
Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome.
Alan H. Morris,C. J. Wallace,Ronald L. Menlove,Terry P. Clemmer,James F. Orme,Lindell K. Weaver,Nathan C. Dean,Frank Thomas,Thomas D. East,Nathan L. Pace,Mary R. Suchyta,E. Beck,M. Bombino,Dean F. Sittig,S. Bohm,B. Hoffmann,H. Becks,S. Butler,John E. Pearl,B Rasmusson +19 more
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In this paper, the authors evaluated the impact of a new therapy that includes pressure-controlled inverse ratio ventilation followed by extracorporeal CO2 removal on the survival of patients with severe ARDS in a randomized controlled clinical trial.Abstract:
The impact of a new therapy that includes pressure-controlled inverse ratio ventilation followed by extracorporeal CO2 removal on the survival of patients with severe ARDS was evaluated in a randomized controlled clinical trial. Computerized protocols generated around-the-clock instructions for management of arterial oxygenation to assure equivalent intensity of care for patients randomized to the new therapy limb and those randomized to the control, mechanical ventilation limb. We randomized 40 patients with severe ARDS who met the ECMO entry criteria. The main outcome measure was survival at 30 days after randomization. Survival was not significantly different in the 19 mechanical ventilation (42%) and 21 new therapy (extracorporeal) (33%) patients (p = 0.8). All deaths occurred within 30 days of randomization. Overall patient survival was 38% (15 of 40) and was about four times that expected from historical data (p = 0.0002). Extracorporeal treatment group survival was not significantly different from other published survival rates after extracorporeal CO2 removal. Mechanical ventilation patient group survival was significantly higher than the 12% derived from published data (p = 0.0001). Protocols controlled care 86% of the time. Average PaO2 was 59 mm Hg in both treatment groups. Intensity of care required to maintain arterial oxygenation was similar in both groups (2.6 and 2.6 PEEP changes/day; 4.3 and 5.0 FIO2 changes/day). We conclude that there was no significant difference in survival between the mechanical ventilation and the extracorporeal CO2 removal groups. We do not recommend extracorporeal support as a therapy for ARDS. Extracorporeal support for ARDS should be restricted to controlled clinical trials.read more
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Journal ArticleDOI
The acute respiratory distress syndrome
TL;DR: An overview of the definitions, clinical features, and epidemiology of the acute respiratory distress syndrome is provided and advances in the areas of pathogenesis, resolution, and treatment are discussed.
Journal ArticleDOI
Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial.
Giles J. Peek,Miranda Mugford,Ravindranath Tiruvoipati,Andrew Wilson,Elizabeth Allen,Mariamma M. Thalanany,Clare Hibbert,Ann Truesdale,Felicity Clemens,Nicola J. Cooper,Richard K. Firmin,Diana Elbourne +11 more
TL;DR: Transfer of adult patients with severe but potentially reversible respiratory failure, whose Murray score exceeds 3.0 or who have a pH of less than 7.20 on optimum conventional management, to a centre with an ECMO-based management protocol is recommended to significantly improve survival without severe disability.
Journal ArticleDOI
Ventilator-induced lung injury: lessons from experimental studies.
Didier Dreyfuss,Georges Saumon +1 more
TL;DR: This paper presents experimental evidence for Increased Vascular Transmural Pressure Evidence for Alterations in Alveolar–Capillary Permeability Contributions of the Static and Dynamic Lung Volume Components to Ventilator-induced Edema High-volume Lung Edema Low Lung Volume Injury.
Journal ArticleDOI
Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Pressure- and Volume-Limited Ventilation Strategy Group.
Thomas E. Stewart,Maureen O. Meade,Deborah J. Cook,John Granton,R. V. Hodder,Stephen E. Lapinsky,C. D. Mazer,R. F. Mclean,T. S. Rogovein,B. D. Schouten,T. R. J. Todd,Arthur S. Slutsky +11 more
TL;DR: In patients at high risk for the acute respiratory distress syndrome, a strategy of mechanical ventilation that limits peak inspiratory pressure and tidal volume does not appear to reduce mortality and may increase morbidity.
Journal ArticleDOI
Acute lung injury and the acute respiratory distress syndrome: a clinical review
TL;DR: Refinements in ventilator and fluid management supported by data from prospective randomised trials have increased the methods available to effectively manage this disorder.
References
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Book
Statistical Power Analysis for the Behavioral Sciences
TL;DR: The concepts of power analysis are discussed in this paper, where Chi-square Tests for Goodness of Fit and Contingency Tables, t-Test for Means, and Sign Test are used.
Book ChapterDOI
Nonparametric Estimation from Incomplete Observations
Edward L. Kaplan,Paul Meier +1 more
TL;DR: In this article, the product-limit (PL) estimator was proposed to estimate the proportion of items in the population whose lifetimes would exceed t (in the absence of such losses), without making any assumption about the form of the function P(t).
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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
The Statistical Analysis of Failure Time Data.
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