Info
🌱 來自: Huppert’s Notes
Acute Respiratory Distress Syndrome (ARDS)🚧 施工中
Acute Respiratory Distress Syndrome (ARDS)
• Berlin Definition. JAMA 2012;307(23):2526–2533.
- This paper defines the ARDS Berlin criteria based on a consensus process by a panel of experts convened in 2011.
• ARMA. New Engl J Med 2000;342(18):1301–1308.
- Multicenter randomized controlled trial that randomized patients with ARDS to ventilation with a lung-protective strategy using lower tidal volumes of 6 mL/kg of predicted body weight (PBW) (goal plateau pressure 25–30 mmHg) vs. conventional mechanical ventilation using tidal volumes of 12 mL/kg of PBW (goal plateau pressure 45–50 mmHg). The use of low tidal volume ventilation (initial TV 6 mL/kg PBW) improved mortality and reduced ventilator-free days compared to traditional tidal volumes (12 mL/kg).
• ALVEOLI Trial. New Engl J Med 2004;351(4):327–336.
- Multicenter, randomized controlled clinical trial that randomized 549 patients with ARDS to receive mechanical ventilation with either lower or higher PEEP levels, set according to different tables of predetermined combinations of PEEP and fraction of inspired oxygen. Among patients with ARDS who received low tidal volume ventilation of 6 mL/kg of predicted body weight and an end-inspiratory plateau pressure limit of 30 cm H2O, there were no differences in clinical outcomes whether lower or higher PEEP levels were used.
• ACURASYS. New Engl J Med 2010;363(12):1107–1116.
- Multicenter, double-blinded, placebo-controlled trial that randomized 340 patients with early severe ARDS (P/F <150) in French ICUs to cisatracurium-induced paralysis or placebo for 48 hours. Paralysis with cisatracurium within 48 hours of severe ARDS onset was associated with improved mortality.
• FACTT Trial. New Engl J Med 2006;354(24):2564–2575.
- Multicenter, two-by-two factorial, randomized controlled trial that randomized 1000 patients with acute lung injury (ALI)/ARDS to a conservative fluid management strategy targeting a CVP <4 mmHg vs. a liberal fluid management strategy targeting a CVP 10–14 mmHg. The conservative fluid strategy improved lung function, decreased ventilator days, and decreased ICU days compared to a liberal fluid strategy, although there was no difference in mortality between groups.
• PROSEVA Trial. New Engl J Med 2013;368(23):2159–2168.
- Multicenter, randomized, open-label trial that randomized 466 patients with severe ARDS to early (<36 hours after intubation) or lengthy (goal 16 hours/day) intermittent prone positioning versus a standard supine position. In patients with severe ARDS, early and prolonged proning was associated with improved 28-day mortality.