Customization of an Open-Lung Ventilation Strategy to Treat a Case of Life-Threatening Acute Respiratory Distress Syndrome.

The ARDS Network low-tidal-volume protocol is considered the standard of care for patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The protocol is built on the foundation of low-tidal-volume ventilation, use of a combined PEEP and FIO2 table, and managing alveolar...

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Publicado en:Respiratory Care Vol. 56; no. 4; pp. 514 - 520
Autores principales: Grooms, David A., Sibole, Stephen H., Tomlinson, James R., Marik, Paul E., Chatburn, Robert L.
Formato: algorithm case study equations & formulas tracings Journal Article
Publicado: Mary Ann Liebert, Inc. Apr2011
Acceso en línea:Ver este registro en EBSCOhost
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      pub: Mary Ann Liebert, Inc.
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        atl: Customization of an Open-Lung Ventilation Strategy to Treat a Case of Life-Threatening Acute Respiratory Distress Syndrome.
      aug:
        au:
          Grooms, David A.
          Sibole, Stephen H.
          Tomlinson, James R.
          Marik, Paul E.
          Chatburn, Robert L.
        affil: Sentara Norfolk General Hospital, Sentara Healthcare System, Norfolk, Virginia.
      sug:
        subj:
          Respiratory Distress Syndrome, Acute Therapy
          Respiration, Artificial Methods
          Waveforms
          Positive End-Expiratory Pressure
          Ohio
          Adult
          Female
          Pneumonia, Aspiration
          Body Weight Evaluation
          Intensive Care Units
          Airway Pressure
          Adult: 19-44 years
          Female
      ab: The ARDS Network low-tidal-volume protocol is considered the standard of care for patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The protocol is built on the foundation of low-tidal-volume ventilation, use of a combined PEEP and FIO2 table, and managing alveolar end-inspiratory pressure by limiting the plateau airway pressure to < 30 cm H2O. Although this strategy, to date, is the only method that significantly improves ALI/ARDS survival, alternative methods of improving hypoxemia and minimizing ventilator-induced lung injury, in conjunction with low-tidal-volume ventilation, can be used for life-threatening ARDS. We present a case in which we customized the use of alveolar recruitment maneuvers by analyzing the hysteresis of the pressure-volume curve to assess lung recruitability, decremental PEEP to sustain lung recruitment, and careful use of plateau pressure > 30 cm H2O, which improved our patient's life-threatening hypoxemia within the first 36 min of arrival to our ICU.
      pubtype: Academic Journal
      doctype:
        algorithm
        case study
        equations & formulas
        tracings
        Journal Article
      ougenre: Article
    language: English
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