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
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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.Abstract:
Background Traditional approaches to mechanical ventilation use tidal volumes of 10 to 15 ml per kilogram of body weight and may cause stretch-induced lung injury in patients with acute lung injury and the acute respiratory distress syndrome. We therefore conducted a trial to determine whether ventilation with lower tidal volumes would improve the clinical outcomes in these patients. Methods Patients with acute lung injury and the acute respiratory distress syndrome were enrolled in a multicenter, randomized trial. The trial compared traditional ventilation treatment, which involved an initial tidal volume of 12 ml per kilogram of predicted body weight and an airway pressure measured after a 0.5-second pause at the end of inspiration (plateau pressure) of 50 cm of water or less, with ventilation with a lower tidal volume, which involved an initial tidal volume of 6 ml per kilogram of predicted body weight and a plateau pressure of 30 cm of water or less. The primary outcomes were death before a patient was discharged home and was breathing without assistance and the number of days without ventilator use from day 1 to day 28. Results The trial was stopped after the enrollment of 861 patients because mortality was lower in the group treated with lower tidal volumes than in the group treated with traditional tidal volumes (31.0 percent vs. 39.8 percent, P=0.007), and the number of days without ventilator use during the first 28 days after randomization was greater in this group (mean [+/-SD], 12+/-11 vs. 10+/-11; P=0.007). The mean tidal volumes on days 1 to 3 were 6.2+/-0.8 and 11.8+/-0.8 ml per kilogram of predicted body weight (P Conclusions 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.read more
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Journal ArticleDOI
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012
R. Phillip Dellinger,Mitchell M. Levy,Andrew Rhodes,Djillali Annane,Herwig Gerlach,Steven M. Opal,Jonathan E. Sevransky,Charles L. Sprung,Ivor S. Douglas,Roman Jaeschke,Tiffany M. Osborn,Mark E. Nunnally,Sean R. Townsend,Konrad Reinhart,Ruth M. Kleinpell,Derek C. Angus,Clifford S. Deutschman,Flávia Ribeiro Machado,Gordon D. Rubenfeld,Steven A R Webb,Richard Beale,Jean Louis Vincent,Rui Moreno +22 more
TL;DR: A consensus committee of 68 international experts representing 30 international organizations was convened in 2008 to provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock".
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Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults
Lionel A. Mandell,Richard G. Wunderink,Antonio Anzueto,John G. Bartlett,G. Douglas Campbell,Nathan C. Dean,Nathan C. Dean,Scott F. Dowell,Daniel M. Musher,Daniel M. Musher,Michael S. Niederman,Michael S. Niederman,Antoni Torres,Cynthia G. Whitney,Michael E. DeBakey Veterans +14 more
TL;DR: This work presents a meta-analyses of the immune system’s response to chronic obstructive pulmonary disease and shows clear patterns of decline in the immune systems of elderly patients with compromised immune systems.
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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
Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.
R. Phillip Dellinger,Mitchell M. Levy,J. Carlet,Julian Bion,Margaret M. Parker,Roman Jaeschke,Konrad Reinhart,Derek C. Angus,Christian Brun-Buisson,Richard Beale,Thierry Calandra,JF Dhainaut,Herwig Gerlach,Maurene A. Harvey,John J. Marini,John C. Marshall,Marco Ranieri,Graham Ramsay,Jonathan E. Sevransky,B. Taylor Thompson,Sean R. Townsend,Jeffrey S. Vender,Janice L. Zimmerman,Jean Louis Vincent +23 more
TL;DR: In this paper, the authors provide an update to the original Surviving Sepsis Campaign clinical management guidelines for management of severe sepsis and septic shock, published in 2004.
Surviving sepsis campaign: international guidelines for the management of severe sepsis and septic shock: 2008
TL;DR: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, the GRADE system was used to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations.
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Journal ArticleDOI
Effect of a Protective-Ventilation Strategy on Mortality in the Acute Respiratory Distress Syndrome
Marcelo B. P. Amato,Carmen Silvia Valente Barbas,D Medeiros,R B Magaldi,Guilherme Schettino,Geraldo Lorenzi-Filho,Ronaldo Adib Kairalla,Daniel Deheinzelin,Carlos Munoz,Roselaine Pinheiro de Oliveira,Teresa Yae Takagaki,Carlos Roberto Ribeiro de Carvalho +11 more
TL;DR: As compared with conventional ventilation, the protective strategy was associated with improved survival at 28 days, a higher rate of weaning from mechanical ventilation, and a lower rate of barotrauma in patients with the acute respiratory distress syndrome.
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