Adjunct Therapies for Pediatric ARDS: Where are the Data?
|
|
- Paulina Wheeler
- 6 years ago
- Views:
Transcription
1 Adjunct Therapies for Pediatric ARDS: Where are the Data? Alexandre T. Rotta, MD, FCCM Professor of Pediatrics, Linsalata Family Endowed Chair in Pediatric Critical Care and Emergency Medicine Rainbow Babies & Children s Hospital Case Western Reserve University, Cleveland, OH
2
3
4
5
6 Pressure-Volume Zones 50 Zone of Volutrauma 40 Volume (ml) Zone of Atelectrauma Pressure (cm H 2 O)
7 Effect of a Protective-Ventilation Strategy on Mortality in the Acute Respiratory Distress Syndrome Amato, MBP, et al. N Engl J Med 1998
8 Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome ARDS Network, N Engl J Med 2000
9 Adjunct Therapies in ARDS HFOV Inhaled Nitric Oxide Corticosteroids Exogenous Surfactant Neuromuscular Blockers Prone Position ETT Suctioning Chest Physiotherapy Epoprostenol 2 -agonists Heliox N-acetylcysteine ECMO 9
10 Adjunct Therapies in ARDS HFOV Inhaled Nitric Oxide Corticosteroids Exogenous Surfactant Neuromuscular Blockers Prone Position ETT Suctioning Chest Physiotherapy Epoprostenol 2 -agonists Heliox N-acetylcysteine ECMO 10
11 Adjunct Therapies in ARDS HFOV Inhaled Nitric Oxide Corticosteroids Exogenous Surfactant Neuromuscular Blockers Prone Position ETT Suctioning Chest Physiotherapy Epoprostenol 2 -agonists Heliox N-acetylcysteine ECMO 11
12 Adjunct Therapies in ARDS Inhaled Nitric Oxide Corticosteroids Exogenous Surfactant Neuromuscular Blockers Prone Position 12
13 Inhaled Nitric Oxide Griffiths MJD, Timothy W. Evans TW. N Engl J Med 2005; 353:
14 Griffiths MJD, Timothy W. Evans TW. N Engl J Med 2005; 353:
15 Griffiths MJD, Timothy W. Evans TW. N Engl J Med 2005; 353:
16
17 Acute Respiratory Distress Syndrome
18 Adhikari NKJ et al, BMJ 2007 Effect of nitric oxide on PaO 2 /FiO 2 ratio at 24 hours
19 Adhikari NKJ et al, BMJ 2007 Effect of nitric oxide on Mortality
20 Dellinger RP, et al. Crit Care Med 1998;26:15 23
21 Inhaled NO in Children with Acute Hypoxemic Respiratory Failure Day RW et al, Chest 1997
22 Dobyns EL, et al. J Pediatr 1999;134:406 12)
23 Dobyns EL, et al. J Pediatr 1999;134:406 12)
24 Dobyns EL, et al. J Pediatr 1999;134:406 12)
25 Dobyns EL, et al. J Pediatr 1999;134:406 12)
26 Dobyns EL, et al. J Pediatr 1999;134:406 12)
27 Patients with OI>25 at enrollment Immunocompromised Patients Dobyns EL, et al. J Pediatr 1999;134:406 12)
28
29
30 Adhikari NKJ et al, Crit Care Med 2013
31 Ruan SY et al, Critical Care Med 2015
32 PALICC Recommendations ino is not recommended for routine use in PARDS. Its use may be considered in patients with documented pulmonary hypertension or severe right ventricular dysfunction. It may be considered in severe cases of PARDS as a rescue from or bridge to extracorporeal life support. When used, assessment of benefit must be undertaken promptly and serially to minimize toxicity and to eliminate continued use without established effect. Tamburro RS, Kneyber MC, for the PALICC Group, 2015
33 How do I Use ino in the PARDS? Rarely, and when forced to Cosmetic therapy: buys hrs of improved oxygenation Start at 20 ppm and attempt to decrease FiO 2 to < 0.6 Monitor frequent ABGs Follow methemoglobin Follow NO 2 measurements Wean by 5 ppm once evidence of improvement Wean by 1 ppm when dose is at 5 ppm Watch for rebound hypoxemia
34 Adjunct Therapies in ARDS Inhaled Nitric Oxide Corticosteroids Exogenous Surfactant Neuromuscular Blockers Prone Position 34
35 Corticosteroids in PARDS No RCTs evaluating glucocorticoids in pediatric ARDS Case reports and small case series Adult data are conflicting
36 36
37 37
38 PALICC Recommendations At this time, corticosteroids cannot be recommended as routine therapy in PARDS. Further study should focus on specific patient populations that are likely to benefit from corticosteroid therapy and specific dosing and delivery regimens. (Strong agreement) Tamburro RS, Kneyber MC, for the PALICC Group, 2015
39 Do I use Steroids in the PARDS? Not routinely Have used methylprednisolone for the very rare and occasional patient if I can find a reasonable justification ARDS in a patient with chronic lung disease Last effort when family not agreeable to ECLS escalation
40 Adjunct Therapies in ARDS Inhaled Nitric Oxide Corticosteroids Exogenous Surfactant Neuromuscular Blockers Prone Position 40
41 Surfactant Control Surfactant 42 children in 8 ICUs Well tolerated Earlier extubation (4.2 days sooner) Earlier discharge from ICU (5 days sooner) No difference in mortality Willson DF, et al Crit Care Med 1999;27:
42 42
43 43
44 Proportion of Calfactant Compared With Placebo Patients Successfully Extubated in the 28 Days After Study Entry
45 45
46 46
47 Thomas NJ et al. Pediatr Crit Care Med,
48 PALICC Recommendations At this time, surfactant therapy cannot be recommended as routine therapy in PARDS. Further study should focus on specific patient populations that may be likely to benefit and specific dosing and delivery regimens. (Strong agreement) Tamburro RS, Kneyber MC, for the PALICC Group, 2015
49 Do I use Surfactant in the PARDS? Not routinely Have used exogenous surfactant in children who are stuck on ECLS with non-recruitable lungs. Have used it as part of a clinical trial
50 Adjunct Therapies in ARDS Inhaled Nitric Oxide Corticosteroids Exogenous Surfactant Neuromuscular Blockers Prone Position 50
51
52 52
53
54 PALICC Recommendations We recommend that if sedation alone is inadequate to achieve effective mechanical ventilation, NMB should be considered. When used, pediatric patients with PARDS should receive minimal yet effective NMB with sedation to facilitate their tolerance to mechanical ventilation and to optimize oxygen delivery, oxygen consumption, and work of breathing. (Strong agreement) Valentine SL, for the PALICC Group, 2015
55 PALICC Recommendations NMB use should be monitored and titrated to goal Consider a daily holiday Clinical trials should report their NMB strategy Further studies are needed (Strong agreement) Valentine SL, for the PALICC Group, 2015
56 Do I use NMB in the PARDS? Yes, my usage matches the PALICC recommendations
57 Adjunct Therapies in ARDS Inhaled Nitric Oxide Corticosteroids Exogenous Surfactant Neuromuscular Blockers Prone Position 57
58 Prone Positioning Supine Prone
59 Gattinoni L, et al. NEJM 2001;234:568 73
60
61
62
63
64
65 65
66 66
67
68
69 PALICC Recommendations Prone positioning cannot be recommended as routine therapy in PARDS. However, it should be considered an option in cases of severe PARDS. Further pediatric study is warranted, particular study stratifying on the basis of severity of lung injury. (Weak agreement) Tamburro RS, Kneyber MC, for the PALICC Group, 2015
70 Do I use Prone Positioning in the PARDS? Yes, my usage matches the PALICC recommendations
71 Adjunct Therapies in ARDS HFOV Inhaled Nitric Oxide Corticosteroids Exogenous Surfactant Neuromuscular Blockers Prone Position ETT Suctioning Chest Physiotherapy Epoprostenol 2 -agonists Heliox N-acetylcysteine ECMO 71
72 Thank You! 72
ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate. Carolyn Calfee, MD MAS Mark Eisner, MD MPH
ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate Carolyn Calfee, MD MAS Mark Eisner, MD MPH June 3, 2010 Case Presentation Setting: Community hospital, November 2009 29 year old woman with
More informationARDS: an update 6 th March A. Hakeem Al Hashim, MD, FRCP SQUH
ARDS: an update 6 th March 2017 A. Hakeem Al Hashim, MD, FRCP SQUH 30M, previously healthy Hx: 1 week dry cough Gradually worsening SOB No travel Hx Case BP 130/70, HR 100/min ph 7.29 pco2 35 po2 50 HCO3
More informationAdjunct Approaches to the Care of the PARDS Patient. Doug Willson, MD Children s Hospital of Richmond April 21, 2015
Adjunct Approaches to the Care of the PARDS Patient Doug Willson, MD Children s Hospital of Richmond April 21, 2015 Disclosures! I am a consultant for Discovery Laboratories! No other conflicts to disclose
More informationGuideline for the Use of inhaled Nitric Oxide (NO) Catarina Silvestre Prof. Harish Vyas
Inhaled Nitric Oxide Title of Guideline Guideline for the Use of inhaled Nitric Oxide (NO) 1a 2a 2b Contact Name and Job Title (author) Directorate & Speciality Date of submission October 2015 Date when
More informationUSE OF INHALED NITRIC OXIDE IN THE NICU East Bay Newborn Specialists Guideline Prepared by P Joe, G Dudell, A D Harlingue Revised 7/9/2014
USE OF INHALED NITRIC OXIDE IN THE NICU East Bay Newborn Specialists Guideline Prepared by P Joe, G Dudell, A D Harlingue Revised 7/9/2014 ino for Late Preterm and Term Infants with Severe PPHN Background:
More informationSub-category: Intensive Care for Respiratory Distress
Course n : Course 3 Title: RESPIRATORY PHYSIOLOGY, PHYSICS AND PATHOLOGY IN RELATION TO ANAESTHESIA AND INTENSIVE CARE Sub-category: Intensive Care for Respiratory Distress Topic: Acute Respiratory Distress
More informationPediatric Acute Respiratory Distress Syndrome (PARDS): Do we have consensus? Doug Willson, MD Children s Hospital of Richmond at VCU April 20, 2015
Pediatric Acute Respiratory Distress Syndrome (PARDS): Do we have consensus? Doug Willson, MD Children s Hospital of Richmond at VCU April 20, 2015 Conflicts to Disclose! I am a consultant for Discovery
More informationOxygenation Failure. Increase FiO2. Titrate end-expiratory pressure. Adjust duty cycle to increase MAP. Patient Positioning. Inhaled Vasodilators
Oxygenation Failure Increase FiO2 Titrate end-expiratory pressure Adjust duty cycle to increase MAP Patient Positioning Inhaled Vasodilators Extracorporeal Circulation ARDS Radiology Increasing Intensity
More informationARDS and Lung Protection
ARDS and Lung Protection Kristina Sullivan, MD Associate Professor University of California, San Francisco Department of Anesthesia and Perioperative Care Division of Critical Care Medicine Overview Low
More informationPro: Early use of VV ECMO for ARDS
Pro: Early use of VV ECMO for ARDS Kyle J. Rehder, MD, FCCP Associate Professor Division of Pediatric Critical Care Medicine Department of Pediatrics Duke Children s Hospital The ventilator is slowly killing
More informationACUTE RESPIRATORY DISTRESS SYNDROME
ACUTE RESPIRATORY DISTRESS SYNDROME Angel Coz MD, FCCP, DCE Assistant Professor of Medicine UCSF Fresno November 4, 2017 No disclosures OBJECTIVES Identify current trends and risk factors of ARDS Describe
More information9/5/2018. Conflicts of Interests. Pediatric Acute Respiratory Distress Syndrome. Objectives ARDS ARDS. Definitions. None
Pediatric Acute Respiratory Distress Syndrome Conflicts of Interests Diane C Lipscomb, MD Director Inpatient Pediatric Medical Director Mercy Springfield Associate Clerkship Clinical Director University
More informationARDS Assisted ventilation and prone position. ICU Fellowship Training Radboudumc
ARDS Assisted ventilation and prone position ICU Fellowship Training Radboudumc Fig. 1 Physiological mechanisms controlling respiratory drive and clinical consequences of inappropriate respiratory drive
More information7/4/2015. diffuse lung injury resulting in noncardiogenic pulmonary edema due to increase in capillary permeability
Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN Objectives Identify the 5 criteria for the diagnosis of ARDS. Discuss the common etiologies
More informationARDS and Ventilators PG26 Update in Surgical Critical Care October 9, 2013
ARDS and Ventilators PG26 Update in Surgical Critical Care October 9, 2013 Pauline K. Park MD, FACS, FCCM University of Michigan School of Medicine Ann Arbor, MI OVERVIEW New Berlin definition of ARDS
More informationLandmark articles on ventilation
Landmark articles on ventilation Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity ARDS AECC DEFINITION-1994 ALI Acute onset Bilateral chest infiltrates PCWP
More informationSCVMC RESPIRATORY CARE PROCEDURE
Page 1 of 7 New: 12/08 R: 4/11 R NC: 7/11, 7/12 B7180-63 Definitions: Inhaled nitric oxide (i) is a medical gas with selective pulmonary vasodilator properties. Vaso-reactivity is the evidence of acute
More informationVentilatory Management of ARDS. Alexei Ortiz Milan; MD, MSc
Ventilatory Management of ARDS Alexei Ortiz Milan; MD, MSc 2017 Outline Ventilatory management of ARDS Protected Ventilatory Strategy Use of NMB Selection of PEEP Driving pressure Lung Recruitment Prone
More informationBack to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill
Back to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill Joe Palumbo PGY-2 Critical Care Pharmacy Resident Buffalo General Medical Center Disclosures
More informationManagement of Severe ARDS: Current Canadian Practice
Management of Severe ARDS: Current Canadian Practice Erick Duan MD FRCPC Clinical Scholar, Department of Medicine, Division of Critical Care, McMaster University Intensivist, St. Joseph's Healthcare Hamilton
More informationARDS: The Evidence. Topics. New definition Breaths: Little or Big? Wet or Dry? Moving or Still? Upside down or Right side up?
ARDS: The Evidence Todd M Bull MD Professor of Medicine Division of Pulmonary Sciences and Critical Care Division of Cardiology Director Pulmonary Vascular Disease Center Director Center for Lungs and
More informationSurviving Sepsis Campaign. Guidelines for Management of Severe Sepsis/Septic Shock. An Overview
Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis/Septic Shock An Overview Mechanical Ventilation of Sepsis-Induced ALI/ARDS ARDSnet Mechanical Ventilation Protocol Results: Mortality
More informationInhaled nitric oxide: clinical evidence for use in adults
Inhaled nitric oxide: clinical evidence for use in adults Neill Adhikari Critical Care Medicine Sunnybrook Health Sciences Centre and University of Toronto 31 October 2014 Conflict of interest Ikaria provided
More informationApplication of Lung Protective Ventilation MUST Begin Immediately After Intubation
Conflict of Interest Disclosure Robert M Kacmarek Managing Severe Hypoxemia!" 9-28-17 FOCUS Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts I disclose
More informationPart 2 of park s Ventilator and ARDS slides for syllabus
Part 2 of park s Ventilator and ARDS slides for syllabus Early Neuromuscular Blockade Question 4 The early use of cis-atracurium in severe ARDS is: A. Contraindicated in patients with diabetes B. Associated
More informationSince the first description of the acute respiratory distress
Pediatric Acute Respiratory Distress Syndrome: Consensus Recommendations From the Pediatric Acute Lung Injury Consensus Conference The Pediatric Acute Lung Injury Consensus Conference Group Objective:
More informationPediatric ARDS. Ira M Cheifetz MD FAARC
Pediatric ARDS Ira M Cheifetz MD FAARC Introduction Defining Pediatric ARDS Conventional Mechanical Ventilation Mode of Ventilation Tidal Volume Peak Inspiratory Pressure PEEP Driving Pressure Recruitment
More informationProvide guidelines for the management of mechanical ventilation in infants <34 weeks gestation.
Page 1 of 5 PURPOSE: Provide guidelines for the management of mechanical ventilation in infants
More informationProne ventilation revisited in H1N1 patients
International Journal of Advanced Multidisciplinary Research ISSN: 2393-8870 www.ijarm.com DOI: 10.22192/ijamr Volume 5, Issue 10-2018 Case Report DOI: http://dx.doi.org/10.22192/ijamr.2018.05.10.005 Prone
More informationSteroids in ARDS: if, when, how much? John Fowler, MD, FACEP Dept. of Emergency Medicine Kent Hospital, İzmir, Türkiye
Steroids in ARDS: if, when, how much? John Fowler, MD, FACEP Dept. of Emergency Medicine Kent Hospital, İzmir, Türkiye Steroids in ARDS: conclusion Give low-dose steroids if indicated for another problem
More informationSubject: Inhaled Nitric Oxide
07-00007-12 Original Effective Date: 04/15/01 Reviewed: 09/27/18 Revised: 10/15/18 Subject: Inhaled Nitric Oxide THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS,
More informationThe use of proning in the management of Acute Respiratory Distress Syndrome
Case 3 The use of proning in the management of Acute Respiratory Distress Syndrome Clinical Problem This expanded case summary has been chosen to explore the rationale and evidence behind the use of proning
More informationYear in Review: Critical Care Medicine
Year in Review: Critical Care Medicine No disclosures Eric J. Seeley, M.D. Assistant Professor of Medicine Division of Pulmonary and Critical Care Medicine Why I Selected These Studies High quality studies
More informationThe new ARDS definitions: what does it mean?
The new ARDS definitions: what does it mean? Richard Beale 7 th September 2012 METHODS ESICM convened an international panel of experts, with representation of ATS and SCCM The objectives were to update
More informationKey words: ARDS; high-frequency oscillation; high-frequency ventilation; mechanical ventilation; respiratory failure
High-Frequency Oscillatory Ventilation in Adults* The Toronto Experience Sangeeta Mehta, MD; John Granton, MD, FCCP; Rod J. MacDonald, RRCP; Dennis Bowman, BSc; Andrea Matte-Martyn, RRT; Thomas Bachman,
More informationAcute Lung Injury/ARDS. Disclosures. Overview. Acute Respiratory Failure 5/30/2014. Research funding: NIH, UCSF CTSI, Glaxo Smith Kline
Disclosures Acute Respiratory Failure Carolyn S. Calfee, MD MAS UCSF Critical Care Medicine and Trauma CME May 30, 2014 Research funding: NIH, UCSF CTSI, Glaxo Smith Kline Medical advisory boards: Cerus
More informationARDS and treatment strategies
ARDS and treatment strategies Geoff Bellingan Medical Director University College Hospital ARDS: Definitions History of predisposing condition Refractory hypoxaemia of acute onset PaO 2 /FiO 2 ratio:
More informationMechanical Ventilation
Mechanical Ventilation Mollie M. James, DO, MPH*, Greg J. Beilman, MD KEYWORDS Mechanical ventilation Respiratory failure ARDS Algorithm KEY POINTS The goal of therapy in patients with acute respiratory
More informationBreathing life into new therapies: Updates on treatment for severe respiratory failure. Whitney Gannon, MSN ACNP-BC
Breathing life into new therapies: Updates on treatment for severe respiratory failure Whitney Gannon, MSN ACNP-BC Overview Definition of ARDS Clinical signs and symptoms Causes Pathophysiology Management
More informationDoes proning patients with refractory hypoxaemia improve mortality?
Does proning patients with refractory hypoxaemia improve mortality? Clinical problem and domain I selected this case because although this was the second patient we had proned in our unit within a week,
More informationBest of Pulmonary Jennifer R. Hucks, MD University of South Carolina School of Medicine
Best of Pulmonary 2012-2013 Jennifer R. Hucks, MD University of South Carolina School of Medicine Topics ARDS- Berlin Definition Prone Positioning For ARDS Lung Protective Ventilation In Patients Without
More informationPAEDIATRIC RESPIRATORY FAILURE. Tang Swee Fong Department of Paediatrics University Kebangsaan Malaysia Medical Centre
PAEDIATRIC RESPIRATORY FAILURE Tang Swee Fong Department of Paediatrics University Kebangsaan Malaysia Medical Centre Outline of lecture Bronchiolitis Bronchopulmonary dysplasia Asthma ARDS Bronchiolitis
More informationInhaled epoprostenol vs inhaled nitric oxide for refractory hypoxemia in critically ill patients
Journal of Critical Care (2013) 28, 844 848 Inhaled epoprostenol vs inhaled nitric oxide for refractory hypoxemia in critically ill patients Heather Torbic PharmD, BCPS a,, Paul M. Szumita PharmD, BCPS
More informationKansas City, MO 2 University of Missouri-Kansas City, MO 3 University of Kansas School of Pharmacy,
in Acute Respiratory Distress Syndrome Joshua R. Howitt, Pharm.D. 1,2,3, John D. Hill, Pharm.D. Candidate 2, Trenton D. Nauser, M.D. 1,4 1 Department of Veterans Affairs, Kansas City, MO 2 University of
More informationOutcomes From Severe ARDS Managed Without ECMO. Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016
Outcomes From Severe ARDS Managed Without ECMO Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016 Severe ARDS Berlin Definition 2012 P:F ratio 100 mm Hg Prevalence:
More informationWhat s New About Proning?
1 What s New About Proning? J. Brady Scott, MSc, RRT-ACCS, AE-C, FAARC Director of Clinical Education and Assistant Professor Department of Cardiopulmonary Sciences Division of Respiratory Care Rush University
More informationKeep. with life MEDICATION TECHNOLOGY SERVICES INSPIRED BY YOUR NEEDS
Keep with life MEDICATION TECHNOLOGY SERVICES INSPIRED BY YOUR NEEDS 2 KINOX MEDICATION KINOX, inhaled nitric oxide, is a selective pulmonary vasodilator developed by Air Liquide Healthcare and characterized
More informationTHE ACUTE RESPIRATORY DISTRESS SYNDROME. Daniel Brockman, DO
THE ACUTE RESPIRATORY DISTRESS SYNDROME Daniel Brockman, DO Objectives Describe the history and evolution of the diagnosis of ARDS Review the diagnostic criteria for ARDS Discuss the primary interventions
More informationUpdate on Pediatric Acute Respiratory Distress Syndrome
Update on Pediatric Acute Respiratory Distress Syndrome Michael R Anderson MD Introduction Ventilatory Management of Pediatric Acute Respiratory Distress Syndrome Lung-Protective Strategies High-Frequency
More informationNeuromuscular Blockade in ARDS
Neuromuscular Blockade in ARDS Maureen O. Meade, MD, FRCPC Critical care consultant, Hamilton Health Sciences Professor of Medicine, McMaster University www.oscillatetrial.com Disclosures None Possible
More informationEPNV-Montreux 2018: Preliminary Educational and Scientific Program
EPNV-Montreux 2018: Preliminary Educational and Scientific Program April 25-26, 2018: Pre-Conference Workshops Wednesday (April 25): 09 00 18 00 Thursday (April 26): 08 00 12 00 April 26-28, 2018: Main
More informationino in neonates with cardiac disorders
ino in neonates with cardiac disorders Duncan Macrae Paediatric Critical Care Terminology PAP Pulmonary artery pressure PVR Pulmonary vascular resistance PHT Pulmonary hypertension - PAP > 25, PVR >3,
More informationOriginal Policy Date
MP 8.01.17 Inhaled Nitric Oxide Medical Policy Section Therapy Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date Reviewed with literature search/12/2013 Return to Medical Policy Index
More informationHypoxemia in the ED. Joseph Shiber, MD, FACP, FACEP, FCCM Director Advanced Lung/ECMO Service Professor of Emergency Medicine, Neurology, and Surgery
Hypoxemia in the ED Joseph Shiber, MD, FACP, FACEP, FCCM Director Advanced Lung/ECMO Service Professor of Emergency Medicine, Neurology, and Surgery 19 y/o woman SOB s/p bicyclist struck Helmeted, no LOC
More informationManagement of refractory ARDS. Saurabh maji
Management of refractory ARDS Saurabh maji Refractory hypoxemia as PaO2/FIO2 is less than 100 mm Hg, inability to keep plateau pressure below 30 cm H2O despite a VT of 4 ml/kg development of barotrauma
More informationNoah Hillman M.D. IPOKRaTES Conference Guadalajaira, Mexico August 23, 2018
Postnatal Steroids Use for Bronchopulmonary Dysplasia in 2018 + = Noah Hillman M.D. IPOKRaTES Conference Guadalajaira, Mexico August 23, 2018 AAP Policy Statement - 2002 This statement is intended for
More information3/5/14. Disclosures. Background. None. No discussion of non FDA approved products
Disclosures None No discussion of non FDA approved products Background Who are the patients at risk for severe hypoxemic respiratory failure? ú Acute Lung Injury (ALI) PaO 2 /FIO 2 300 ú Acute Respiratory
More informationHazards and Benefits of Postnatal Steroids. David J. Burchfield, MD Professor and Chief, Neonatology University of Florida
Hazards and Benefits of Postnatal Steroids David J. Burchfield, MD Professor and Chief, Neonatology University of Florida Disclosures I have no financial affiliations or relationships to disclose. I will
More informationOutline. Basic principles of lung protective ventilation. The challenging areas. Small tidal volumes Recruitment
ARDS beyond 6/kg Gordon D. Rubenfeld, MD MSc Professor of Medicine, University of Toronto Chief, Program in Trauma, Emergency, and Critical Care Sunnybrook Health Sciences Centre Outline Basic principles
More informationMEDICAL POLICY I. POLICY POLICY TITLE POLICY NUMBER INHALED NITRIC OXIDE MP-4.021
Original Issue Date (Created): August 23, 2002 Most Recent Review Date (Revised): January 28, 2014 Effective Date: April 1, 2014 I. POLICY Inhaled nitric oxide may be considered medically necessary as
More informationPolicy #: 440 Latest Review Date: May 2016
Name of Policy: Inhaled Nitric Oxide Policy #: 440 Latest Review Date: May 2016 Category: Therapy Policy Grade: B Background/Definitions: As a general rule, benefits are payable under Blue Cross and Blue
More informationRESCUE VENTILATION SUMMARY
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care
More informationEarlier Use of Inhaled Nitric Oxide in Term and Near-Term Neonates With Hypoxic Respiratory Failure (HRF) and Pulmonary Hypertension (PH)
Earlier Use of Inhaled Nitric Oxide in Term and Near-Term Neonates With Hypoxic Respiratory Failure (HRF) and Pulmonary Hypertension (PH) 2013 Ikaria, Inc. 1 Disclosure Information This program is sponsored
More informationECMO and refractory Hypoxemia
ECMO and refractory Hypoxemia Dr. Vinay Dhingra MD FRCPC Clinical Associate Professor of Medicine Clinical Lead Critical Care BCPSQC Medical Director Quality VGH Disclosures ARDS Lancet 1967; 2:319-323
More informationCardiorespiratory Interactions:
Cardiorespiratory Interactions: The Heart - Lung Connection Jon N. Meliones, MD, MS, FCCM Professor of Pediatrics Duke University Medical Director PCVICU Optimizing CRI Cardiorespiratory Economics O2:
More informationPhysician Orders PEDIATRIC: LEB Critical Care Respiratory Plan
LEB Critical Care Respiratory Plan Patient Care Cardiopulmonary Monitor T;N Routine, Monitor Type: End Tidal Co2 (DEF)* T;N Routine, Monitor Type: Transcutaneous Co2 Respiratory Care Initiate Pediatric
More informationAdjuvants to Mechanical Ventilation for Acute Respiratory Failure
Adjuvants to Mechanical Ventilation for Acute Respiratory Failure by Laveena Munshi A thesis submitted in conformity with the requirements for the degree of Masters of Science Institute of Health Policy,
More informationCOBIS Management of airway burns and inhalation injury PAEDIATRIC
COBIS Management of airway burns and inhalation injury PAEDIATRIC 1 A multidisciplinary team should provide the management of the child with inhalation injury. Childhood inhalation injury mandates transfer
More informationWhat is the next best step?
Noninvasive Ventilation William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center What is the next best step? 65 year old female
More informationNoninvasive Ventilation: Non-COPD Applications
Noninvasive Ventilation: Non-COPD Applications NONINVASIVE MECHANICAL VENTILATION Why Noninvasive Ventilation? Avoids upper A respiratory airway trauma system lacerations, protective hemorrhage strategy
More informationGuidelines and Best Practices for High Flow Nasal Cannula (HFNC) Pediatric Pocket Guide
Guidelines Best Practices for High Flow Nasal Cannula (HFNC) Pediatric Pocket Guide Patient Selection Diagnoses Patient presents with one or more of the following signs or symptoms of respiratory distress:
More informationVentilator ECMO Interactions
Ventilator ECMO Interactions Lorenzo Del Sorbo, MD CCCF Toronto, October 2 nd 2017 Disclosure Relevant relationships with commercial entities: none Potential for conflicts within this presentation: none
More informationECMO FOR PEDIATRIC RESPIRATORY FAILURE. Novik Budiwardhana * PCICU Harapan Kita National Cardiovascular Center Jakarta
ECMO FOR PEDIATRIC RESPIRATORY FAILURE Novik Budiwardhana * PCICU Harapan Kita National Cardiovascular Center Jakarta Introduction Case D 8 month old baby with severe ARDS with fungal sepsis. He was on
More informationDAILY SCREENING FORM
DAILY SCREENING FORM Patient s initials: Date of admission: Time of admission: Gender: M F Year of Birth: Type of admission: Medical/Surgical/Postoperative (elective) Days Date Mechanical ventilation Lung
More informationPEEP recruitment maneuver
Robert M. Rodriguez, MD FAAEM Clinical Professor of Medicine and Emergency Medicine, UCSF Case 1: 40 yo Male restrained driver high speed MVA P 140, RR 40 labored, BP 100/70, O 2 sat 70 Chest wheeze, crackles
More informationAPPENDIX VI HFOV Quick Guide
APPENDIX VI HFOV Quick Guide Overall goal: Maintain PH in the target range at the minimum tidal volume. This is achieved by favoring higher frequencies over lower P (amplitude). This goal is also promoted
More informationLong-Term Survival in Patients With Severe Acute Respiratory Distress Syndrome and Rescue Therapies for Refractory Hypoxemia*
Long-Term Survival in Patients With Severe Acute Respiratory Distress Syndrome and Rescue Therapies for Refractory Hypoxemia* Nita Khandelwal, MD, MS 1 ; Catherine L. Hough, MD, MS 2 ; Aasthaa Bansal,
More informationARDS: MANAGEMENT UPDATE
ARDS: MANAGEMENT UPDATE Tanıl Kendirli, Assoc. Prof. Ankara University School of Medicine, Pediatric Critical Care Medicine The AECC Definition Timing Acute onset, within 48-72 hours Oxygenation ALI PaO2/FiO2
More informationAuthor: Thomas Sisson, MD, 2009
Author: Thomas Sisson, MD, 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Non-commercial Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/
More informationVentilation update Anaesthesia departmental PGME. Tuesday 10 th December Dr Alastair Glossop Consultant Anaesthesia and Critical Care
Ventilation update Anaesthesia departmental PGME Tuesday 10 th December Dr Alastair Glossop Consultant Anaesthesia and Critical Care What s fashionable in ICU ventilation? Acute respiratory distress syndrome
More informationAcute Respiratory Distress Syndrome (ARDS) An Update
Acute Respiratory Distress Syndrome (ARDS) An Update Prof. A.S.M. Areef Ahsan FCPS(Medicine) MD(Critical Care Medicine) MD ( Chest) Head, Dept. of Critical Care Medicine BIRDEM General Hospital INTRODUCTION
More informationACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv.8.18.18 ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) SUDDEN PROGRESSIVE FORM OF ACUTE RESPIRATORY FAILURE ALVEOLAR CAPILLARY MEMBRANE BECOMES DAMAGED AND MORE
More informationSWISS SOCIETY OF NEONATOLOGY. Preterm infant with. pulmonary hypertension and hypopituitarism
SWISS SOCIETY OF NEONATOLOGY Preterm infant with pulmonary hypertension and hypopituitarism November 2007 2 Pilgrim S, Stocker M, Neonatal and Pediatric Intensiv Care Unit, Children s Hospital of Lucerne,
More informationARDS Survival: Building A Roadmap to Achieve Successful Short and Long Term Outcomes
ARDS Survival: Building A Roadmap to Achieve Successful Short and Long Term Outcomes Kathleen Vollman MSN, RN, CCNS, FCCM, FAAN Clinical Nurse Specialist/Educator/Consultant LLC Director/Ambassador WFCCN
More information1
1 2 3 RIFAI 5 6 Dublin cohort, retrospective review. Milrinone was commenced at an initial dose of 0.50 μg/kg/minute up to 0.75 μg/kg/minute and was continued depending on clinical response. No loading
More informationPulmonary Vasodilator Treatments in the ICU Setting
Pulmonary Vasodilator Treatments in the ICU Setting Lara Shekerdemian Circulation 1979 Ann Thorac Surg 27 Anesth Analg 211 1 Factors in the ICU Management of Pulmonary Hypertension After Cardiopulmonary
More informationLiberation from Mechanical Ventilation in Critically Ill Adults
Liberation from Mechanical Ventilation in Critically Ill Adults 2017 ACCP/ATS Clinical Practice Guidelines Timothy D. Girard, MD, MSCI Clinical Research, Investigation, and Systems Modeling of Acute Illness
More informationCASE PRESENTATION VV ECMO
CASE PRESENTATION VV ECMO Joshua Huelster, MD Fellow in Critical Care Medicine Department of Pulmonary and Critical Care Medicine Hennepin County Medical Center Disclosure There are no conflicts of interest
More informationOSCAR & OSCILLATE. & the Future of High Frequency Oscillatory Ventilation (HFOV)
& & the Future of High Frequency Oscillatory Ventilation (HFOV) www.philippelefevre.com What do we know already? Sud S et al. BMJ 2010 & Multi-centre randomised controlled trials of HFOV verses current
More informationSeminar. Current Concepts
Seminar Current Concepts In ARDS What I think is possible to cover in 40 minutes- Definition Management Ventilatory strategies Conventional LPV Rescue therapy Non Ventilatory strategies Definition and
More informationIntroduction Definition Etiology Epidemiology Lung injury prediction score. Pathophysiology Diagnosis Clinical presentation Management Conclusion
Introduction Definition Etiology Epidemiology Lung injury prediction score Pathophysiology Diagnosis Clinical presentation Management Conclusion During the 1960s, a distinct type of a life threatening
More informationICU management and referral guidelines for severe hypoxic respiratory failure
Aim: ICU management and referral guidelines for severe hypoxic respiratory failure 1) To provide a concise management plan Non ventilatory Ventilatory 2) Timeline for referring patient with refractory
More informationNoninvasive respiratory support:why is it working?
Noninvasive respiratory support:why is it working? Paolo Pelosi Department of Surgical Sciences and Integrated Diagnostics (DISC) IRCCS San Martino IST University of Genoa, Genoa, Italy ppelosi@hotmail.com
More informationHypoxic Respiratory Failure in the Newborn. Question and Answer
Hypoxic Respiratory Failure in the Newborn Question and Answer Question: When administering nitric oxide to premature babies what is considered safe or common practice in terms of length of treatment?
More informationEarly Rehabilitation in the ICU: Do We Still Need Chest Physiotherapy?
Early Rehabilitation in the ICU: Do We Still Need Chest Physiotherapy? Michelle Kho, PT, PhD Assistant Professor, School of Rehabilitation Science, McMaster University Adjunct Assistant Professor, Department
More informationRespiratory Distress During RSV Season
Respiratory Distress During RSV Season Carroll King, MD, FAAP Disclosure : Carroll King, MD, FAAP has nothing to disclose. 1 Objectives At the end of this educational activity, participants should be able
More informationAPRV Ventilation Mode
APRV Ventilation Mode Airway Pressure Release Ventilation A Type of CPAP Continuous Positive Airway Pressure (CPAP) with an intermittent release phase. Patient cycles between two levels of CPAP higher
More informationICU Management of Minimally Invasive Cardiac Surgery
ICU Management of Minimally Invasive Cardiac Surgery Benjamin A. Kohl, MD, FCCM Chief of Critical Care, Aria-Jefferson Health Professor of Anesthesiology Thomas Jefferson University Sidney Kimmel Medical
More informationExtracorporeal Membrane Oxygenation (ECMO) Referrals
Children s Acute Transport Service Clinical Guideline Extracorporeal Membrane Oxygenation (ECMO) Referrals Document Control Information Author ECMO/CATS Author Position Service Coordinator Document Owner
More informationDifficult Ventilation in ARDS Patients
Thank you for viewing this presentation. We would like to remind you that this material is the property of the author. It is provided to you by the ERS for your personal use only, as submitted by the author.
More information